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Before/After Photos => Other => Topic started by: dammit_daniel on March 29, 2018, 01:56:12 PM
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Hi all. I have an appointment to see a maxillofacial surgeon concerning my poor breathing, especially worse at night when I lie down, I have to arch my neck back to get sufficient air. I always wake up unrefreshed, so I had a sleep study done but they said I did not have apnea, however my sleep architecture was very poor, getting little deep sleep, and also having quite a few arousals. Even though the sleep study came back negative for apnea I am still convinced that breathing difficulties at night time are causing my poor sleep, this is because I have had some improvement in my sleep using jaw advancement devices and cpap(both however I cannot tolerate consistently). I believe my receding jaw is to blame for this, as it feels like my tongue is constantly pressing against my soft pallet making it difficult to breath. Can anyone answer the following questions?
1) Do you think the maxillofacial surgeon will perform the same type of surgery for sleep apnea(bimax and genio?) to open up my airways even though I dont have sleep apnea?
2) From the xray do you think the doctor will be able to say with some certainty that "x" is causing my poor sleep/poor breathing? i.e are there some common anatomy traits that leave some more predisposed to poor breathing during sleep/in general?
3) Has anyone had an improvement in speech after having surgery for a receding jaw?
Thanks.
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Hi there,
Do you know if your sleep study ruled out the possibility of Upper Airway Resistance Syndrome (UARS) https://www.sleepassociation.org/sleep-disorders/more-sleep-disorders/upper-airway-resistance-syndrome/ (https://www.sleepassociation.org/sleep-disorders/more-sleep-disorders/upper-airway-resistance-syndrome/)? Many of the symptoms are similar to OSA. However, those with UARS might not experience snoring or oxygen desaturation the way someone with OSA would.
If you do have UARS and can provide documentation of the diagnosis, and demonstrate that you cannot tolerate CPAP/oral devices long term, then I think you might have a shot at getting approval for bi-max + genio, depending on your insurance co. Those were the steps I had to take for getting my surgery approved (though I have OSA, not UARS). That said, UARS can also be a result of soft tissue issues, so you'd need to have a surgeon determine where you are having obstruction issues. This would then determine which procedure(s) would be effective for resolving the obstruction.
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Your eggs are not all in one basket in so far as what your desires to have max fax surgery relate to. Nor is any X ray here. Your other X ray in an other post was a PANORAMIC and that type is not used to look at airways or jaw imbalance.
Are you wanting to know IF insurance will pay for it? NO, if it does not pan out as 'apnea' from the tests.
Are you wanting to pay for it yourself because you want to improve the AESTHETICS of your receding jaw and ALSO because your bite is 'not right'? IF 'yes' to those 2 things, then the max fax can LOOK at the part of the airway which will increase in dimention subsequent to advancing the jaw(s). Nothing 'lost' IF the surgery will improve your aesthetics and bite even if the part of the airway being increased in dimention is not the part of it giving you breathing problems.
If all you want to consider is getting 'some surgery' aimed at breathing better that is not maxfax when done with either the priority of 'apnea' OR jaw/bite imbalance, then you would need to probably consult with some rhinoplasty doctors to see if anything in your NOSE is kicking up breathing problems.
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Hi Bex,
Yes, I think I do have UARS. The sleep study unfortunately did not measure Respiratory Disturbance Index, which I think would of been vital in a diagnosis. I have tried a mouthguard, it has definitely helped. The only problem is a get ringing ears from it and I need to take sleeping tablets to help with the discomfort, which is not ideal long term. I tried CPAP , not sure if my anatomy is not suitable for it or something but I haven't been able to get used to it.
What surgery did you have for OSA?
Thanks
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Hi Kavan,
I see, yes I got the panaromic from my dentist, as I have no proper xrays yet. I do have a max fac appointment tomorrow with xrays/imaging involved, which I'll post if it shows anything interesting.
I have had a septoplasty and turbinate reduction, so I think my nose is quite clear.
Awesome, thanks for the info.
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Hi Kavan,
I see, yes I got the panaromic from my dentist, as I have no proper xrays yet. I do have a max fac appointment tomorrow with xrays/imaging involved, which I'll post if it shows anything interesting.
I have had a septoplasty and turbinate reduction, so I think my nose is quite clear.
Awesome, thanks for the info.
Hmmm...usually the septos and turb redux are aimed at helping the breathing.
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Unless the issue really isn't with the nose.
Daniel, yes from your xray the surgeon will be able to see your airway, however, keep in mind the xray is taken while upright, not lying down, so it won't reveal what happens to your airway when you're down.
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Thanks April, right, I hope they can see the problem from sitting up then. I have read some other posts where the surgeon has said their airways are narrow and would be even more narrow when lying down, which might cause breathing issues. Hopefully my surgeon has good eye for these things.
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So I met with the first of 2 max fac surgeons I am seeing and he pretty much said he wouldn't do anything until I had a diagnosis of sleep apnea. He would not even comment on my airways or tell me about normal airway sizes..he did give me the xrays so I am wondering if anyone could comment on my xrays or tell me what measurements would be useful?
I have a side profile view.
https://imgur.com/a/yecWsvJ
Are there any measurements from the top down views which would be helpful?
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Please AVOID using oral appliances!!!! I cannot stress that enough.
I had to undergo double jaw surgery because I wore an oral appliance for 5 years. It affected my jaw joint and tipped all my teeth to the point where the roots were coming out of the bone. Because I was no longer able to chew food properly (no contact with a mouthful of crooked teeth) I was forced to redo orthodontia at 60 years old. The orthodontist insisted I get the surgery as part of the treatment to straighten my teeth. I've always had a weak jaw and a slight overbite and he felt that the jaws needed to be aligned better to give me a proper bite. I paid out of pocket for both the orthodontist and the double jaw surgery, after already investing in a CPAP and $2K oral appliance.
I am a moderate (40 episodes/hr) apnea sufferer. My first sleep study revealed 2 minutes REM sleep in the entire night! They diagnosed me with Upper Airway Resistance Syndrome as well as Obstructive Sleep Apnea. Initially, with the oral appliance I was down to under 10 episodes/hr if I slept on my side. As my teeth tipped from the constant pressure the device was less effective. I did well with CPAP but could never find a proper mask to fit my very small face and the constant leaks woke both me and my husband. At the time the sleep specialist said the surgery would not fix my sleep problems and to stick with CPAP.
The oral surgeon did an x-ray of my airway and determined that it was nearly pinched off where my jaw meets my neck. I have a really thin neck. The airway on the 3-d image looked bone shaped and very narrow in the middle. The oral surgeon explained that by advancing both jaws he could open the airway at that point to look like the rest of it. In the end he had to advance the upper jaw by 1 cm and lower one by 2 cm (which he said was significant), and on the post-surgery x-ray I now have a normal looking airway.
As for sleep and apnea - I am in recovery, which means sleeping on my back with an elevated head. I quit the CPAP since it is no longer titrated to whatever I am now. In a few months I hope to: 1. sleep on my side, which helps OSA & 2. get another sleep study done. I'm not waking perfectly refreshed, but I am not healed from surgery yet either. I am definitely NOT the mess that I was when I had moderate apnea. I am happy to have a normal airway, regardless. I am looking forward to getting the orthodontist to fix my bite and straighten my teeth to be able to finally chew well.
Good luck in whatever you decide but carefully consider your options and the long term ramifications.
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wendyl, how are you doing now? Were there any concerns at such a major advancement and major surgery considering your age?
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Hello, I am 50 and had both upper and lower jaws advanced a full centimeter for sleep apnea issues relating to my throat closing and inability to wear a CPAP. The surgery totally cured my sleep issues and is just a major healing issue. I'm 6 weeks out now and still having a lot of pain and issues. I'm sure I will be super happy about it a few months later. At the moment I have mixed feelings between, glad I just got a great sleep than "why the hell did I do this to myself". Its painful and really hard to adjust to..
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I'm at 5 months now and I'm not quite satisfied with how much my breathing/sleep has improved. I am still having to sleep sitting upright or have my head quite elevated. I am much more functional now however. I've seen improvements in memory, energy, wakefulness.
I'm now exploring other options in particular a genioplasty. My surgeon offered me a genioplasty at the time of the bimax, but he said I only needed 2-3mm advancement, so I didn't bother. People on this forum have already advised me on getting a genioplasty for further improvement.
I'm contacting my surgeon but any opinions would be greatly appreciated.
Does anyone here know of people that have had much success with the genioplasty for airway increase?
And any opinions on how much genio advancement I could get away with without looking weird? (I might even go with looking weird if it meant more chance of being cured)
https://imgur.com/a/Tn6nbeP -couple months post op, still had quite a bit of swelling.
Cheers
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I'm at 5 months now and I'm not quite satisfied with how much my breathing/sleep has improved. I am still having to sleep sitting upright or have my head quite elevated. I am much more functional now however. I've seen improvements in memory, energy, wakefulness.
I'm now exploring other options in particular a genioplasty. My surgeon offered me a genioplasty at the time of the bimax, but he said I only needed 2-3mm advancement, so I didn't bother. People on this forum have already advised me on getting a genioplasty for further improvement.
I'm contacting my surgeon but any opinions would be greatly appreciated.
Does anyone here know of people that have had much success with the genioplasty for airway increase?
And any opinions on how much genio advancement I could get away with without looking weird? (I might even go with looking weird if it meant more chance of being cured)
https://imgur.com/a/Tn6nbeP -couple months post op, still had quite a bit of swelling.
Cheers
There are different type of genioplasties, specifically designed to open airways, like below.
https://ai2-s2-public.s3.amazonaws.com/figures/2017-08-08/f5922c5b354a9e3fd5b2f3d0860efbebc323bcb6/4-Figure2-1.png
https://encrypted-tbn0.gstatic.com/images?q=tbn:ANd9GcRZd_4BwpsNx7leZPcpw0sHjzzwJFuNbEk8BlGibRRLTnQnY6l1
https://encrypted-tbn0.gstatic.com/images?q=tbn:ANd9GcSi6jMkU6uRrJEz5V6IvqNdmhUhDRXqL2__9Pxg06mtw1FrJ7IA6A
Aesthetically, I think your profile can handle more advancement. In case of a genioplasty, I think it may be more if it can make your chin look pointy or sharp if it's too much. Also looking at things like labiomental fold etc. Best is probably to ask your surgeon what he can do, and maybe ask specifically for these type of genioglossus advancement, and not normal genioplasty, if you're especially interested in opening the airways.
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As always, really appreciate the input Dogmatix. :)
I'll make sure to ask about the "Genioglossus advancement" image you linked.
I think my chin may end up looking quite sharp and pointy, as its quite narrow.
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As always, really appreciate the input Dogmatix. :)
I'll make sure to ask about the "Genioglossus advancement" image you linked.
I think my chin may end up looking quite sharp and pointy, as its quite narrow.
Glad where I can contribute :)
I think it may be a good idea for you to investigate your current OSA status and take x-rays to see what it actually looks like. You had a rather significant advancement and it sounds strange that you don't experience more difference. Can it be that it is something else giving you these problems? Just so you don't throw yourself into surgery.
I have seen before and after cbct x-rays of patient who've had MMA for OSA, and it can look dramatically different in context of airways volume after such advancement. It would be interesting to know if you also have this dramatic change in your x-rays. If you're serious about doing another surgery, your surgeon will probably take another cbct. Ask him to sit down with you and compare your preop cbct airways with your post-op cbct airways so you get a good understanding of what has been achieved, and what the additional benefit can be.
Also, I think genioplasty in general will pull to open the airways, and not only the special designed ones I posted above. I think the biggest difference is that they twist the segment, which pulls the genioglossus more forward to specifically open the airways more.
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The only thing you can do at this point is to do what was suggested to you in the FIRST place by your maxfax which was to get the genio to assist with creating more airway space. You refused it and took the time to 'wait and see' how not getting what was suggested worked out for you. So, now you see how NOT getting what was suggested to you as part of the surgery worked out for you. I would just assume that it didn't work out for you AS WELL as others who got the genio at the surgeons ORIGINAL suggestion. Hence, at this point in time, consider just doing the genio the doc suggested to you in the first place. If your surgeon did you good, which seems to be the case, by doing the MOST of the surgery, than maybe consider trusting his advice to go through with the REST of it; the genio he suggested in the first place
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Ideally you should have had a lot more CCW rotation. Although that would've been more risk and I'm not sure if your surgeon could've done it anyway.
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Thanks for the input guys.
Hey Kavan, at the time of discussion with the surgeon he made it sound like the genio was only cosmetic and my it sound like chin was only a few mm behind the "ideal". But yeah i guess ill go for as much advancement w/ genioclossus now.
Plosko i think i actually got less rotation and more linear advancement due to not needed it, according to the surgeon. I'll link my xray in a sec.
I thought the movement was quite large, so the result is disapointing. Although he did say my airway was more narrow than apnea patients he had seen. And my advancement was the max he was happy to do, due to relapse apparently.
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Thanks for the input guys.
Hey Kavan, at the time of discussion with the surgeon he made it sound like the genio was only cosmetic and my it sound like chin was only a few mm behind the "ideal". But yeah i guess ill go for as much advancement w/ genioclossus now.
Plosko i think i actually got less rotation and more linear advancement due to not needed it, according to the surgeon. I'll link my xray in a sec.
I thought the movement was quite large, so the result is disapointing. Although he did say my airway was more narrow than apnea patients he had seen. And my advancement was the max he was happy to do, due to relapse apparently.
Wow. He should have told you it would help with the airway. Oh well. No problem if you've decided to get it. It should help.
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Ideally you should have had a lot more CCW rotation. Although that would've been more risk and I'm not sure if your surgeon could've done it anyway.
Yeah, sounds like an excuse for a lack of skill. More CCW would've improved his airway, and the genio would've probably been unnecessary as well. His chin looks fine.
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Ideally you should have had a lot more CCW rotation. Although that would've been more risk and I'm not sure if your surgeon could've done it anyway.
Have in mind that there have been 7mm vertical displacement of PNS. Is it sensible to advice on "a lot more ccw" from this point?
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Have in mind that there have been 7mm vertical displacement of PNS. Is it sensible to advice on "a lot more ccw" from this point?
https://imgur.com/a/uVYEBZV - Morph and Post op ceph
Hmm yeah the plan was 7mm Dogmatix. Is there a general rule of maximum vertical displacement of the PNS to prevent Non-union and relapse happening?
Maybe he did as much as he could and my bone structure is just that f**ked up. Like I said the surgeon said my airway was more narrow than people he had seen with sleep apnea.
f you're serious about doing another surgery, your surgeon will probably take another cbct. Ask him to sit down with you and compare your preop cbct airways with your post-op cbct airways so you get a good understanding of what has been achieved, and what the additional benefit can be.
I looked at (what I think is) my hyoid bone location(linked below) on my pre op CBCT. To my untrained eye it looks like the anterior side of my hyoid bone was taking up too much of my airways. My theory is that my hyoid bone is placed too far back in my airways as a result of my recessed lower jaw and the jaw surgery didn't correct the hyoid bone.
https://imgur.com/a/L43WsGA -pre op cbct
Yeah a cbct sounds like a really good idea. I didn't think of that.
I guess there is a reason why OSA patients have maximum advacement of jaws AND CHIN to really annihilate OSA. I'm thinking my surgeon didn't really take my case seriously enough to educate me on getting a large genioplasty/genioglossus. I guess if I end up getting the chin done and it works maybe others can take this as a lesson lol.
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There's a separate surgery for the hyoid bone.
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I know there is a hyoid suspension surgery but I have also read medical articles that claim that the hyoid bone also moves with chin advancement.
Do you know if hyoid suspension is very effective?
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It's refreshing to see both yourself and fresh DJ feeling better than before.
- Soft Palate
- Hyoid
- Nose
- Nasal Cavity
- Jaw
All should be checked out to make sure they're not causing any obstruction to your breathing. Hope you get to the bottom of it. If you do find something else that is responsible for your issue, do let us know.
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Thanks for the tips Journey. I'm lining up an appointment with an ENT who specializes in sleep disorders who also does cone beam scans. I'm still keeping chin movements in mind though.
I do worry about surgeons recommending only operations they know how to perform. You know the saying, a hammer thinks everything is a nail. I just hope for ethical and wise doctors.
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So after seeing an ENT and getting a cone beam scan, the ENT thinks I have upper tongue collapse and thinks a midline tongue reduction should help me. See below for image.
https://imgur.com/a/rlM4vD6
I'm actually pushing for a genioglossus advancement from my old jaw surgeon as well. Anyone think that advancing the genioglossus muscle could help my situation at all?
The bimax has actually opened my airways quite a bit https://imgur.com/a/5SzjfaJ , my old cone beam, if anyone is interested in seeing the effect.
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So after seeing an ENT and getting a cone beam scan, the ENT thinks I have upper tongue collapse and thinks a midline tongue reduction should help me. See below for image.
https://imgur.com/a/rlM4vD6
I'm actually pushing for a genioglossus advancement from my old jaw surgeon as well. Anyone think that advancing the genioglossus muscle could help my situation at all?
The bimax has actually opened my airways quite a bit https://imgur.com/a/5SzjfaJ , my old cone beam, if anyone is interested in seeing the effect.
What are the meassurements of the min-area, and the volume? Dö you have these meassurements from pre-op as well?
Advancing the genioglossus will of course do something as it's attached to what you wish to move. Question is how much and if it's worth it. First would be to know what kind of advancement and surgery you can be offered.
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So after seeing an ENT and getting a cone beam scan, the ENT thinks I have upper tongue collapse and thinks a midline tongue reduction should help me. See below for image.
https://imgur.com/a/rlM4vD6
I'm actually pushing for a genioglossus advancement from my old jaw surgeon as well. Anyone think that advancing the genioglossus muscle could help my situation at all?
The bimax has actually opened my airways quite a bit https://imgur.com/a/5SzjfaJ , my old cone beam, if anyone is interested in seeing the effect.
I would do that FIRST since it's consistent with helping breathing and probably a better chin aesthetic. Save the ENT tongue cut option for later.
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I would do that FIRST since it's consistent with helping breathing and probably a better chin aesthetic. Save the ENT tongue cut option for later.
I thought the genioglossus advancement was always used for people with apnea/narrow airways, my limited understanding was that moving the genioglossus moved the hyoid and base of tongue forward. But my ENT is saying that the genioglossus advancement only moves the lower base of tongue forward and won't do anything for upper tongue base collapse, which is what he has diagnosed me with from his endoscopic inspection & cone beam scan. He thinks that a midline glossectomy has a 70% chance of fixing my issue. I was sceptical of the ENT dismissing the genioglossus advancement though, him being an ENT he doesn't perform that surgery so I thought of course he would dismiss it. He later also revealed he didn't want to work in the other surgeons hospital and that the logistics of both the surgeries at once might be to hard..so I was even more sceptical of him now and his tongue surgery suggestion. He did seem genuine in his advice though. I think he's only performed the tongue surgery 5 times, but he claims to have a 100% success rate at curing apnea.
It's all quite hard to make a good judgement call. I could potentially even look for another sleep surgeon ENT, although they're quite hard to find and would mean an even longer wait for surgery with intial consultations etc. I'm just talking out loud here by the way.
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What are the meassurements of the min-area, and the volume? Dö you have these meassurements from pre-op as well?
Advancing the genioglossus will of course do something as it's attached to what you wish to move. Question is how much and if it's worth it. First would be to know what kind of advancement and surgery you can be offered.
Hey, I can get you some measurements on the weekend, I would appreciate your advice, I think we had a good medical article with healthy airway areas. I might dig that up.
By the way my old jaw surgeon is not even keen to do the genioglossus advancement unless I get a sleep study AND an ENT refferal. And my ENT is not backing the genioglossus advancement. And my jaw surgeon doesn't want to make any calls if the genioglossus advancement is appropriate for my issue.
I previously discussed the surgery with the jaw surgeon. It would be the surgery where a rectangle is cut below your lower teeth, which tries to capture where the genioglossus muscle is attached to your chin, and the rectangle is advanced forward and turned 90 degrees and screwed into your chin. I think I read somewhere the advancement is usually 6mm, or the width of your chin bone.
Does this improve chin aesthetics somehow? Does the labial fold become less pronounced or something? otherwise I can't imagine how the chin would look better?
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Well, you are going through a logical thinking process in this regard. I think it is good, in this situation to be somewhat skeptical and you are clear in expressing what you are not so sure of. I've done some reading on this. But of course, it's not a subject I'm highly familiar with either. What he's telling you is that you have a 'FAT' tongue and he can remove part of it.
His advice is to have HIS surgery FIRST or INSTEAD of chin advancement. Mine is to have the chin advancement FIRST and his surgery later IF the chin surgery does not assist in better breathing. Now, ASSUMING that chin advancement would yield an aesthetic improvement whether or not it also improved breathing in your case, my decision analysis goes something like this:
Chin surgery first. If you have the chin surgery first, there are 2 basic outcomes:
1: Aesthetic improvement with NO improvement to breathing.
2: Aesthetic improvement WITH improvement to breathing.
Either way, you get aesthetic improvement from it. IF #1, you confirm his diagnosis is right and you then STILL have option of having his surgery. IF #2, you confirm, you don't need his surgery.
Tongue surgery first.
1: Improvement to breathing but no aesthetic benefit.
2: No or not much improvement to breathing and no aesthetic benefit.
Either way, there is no aesthetic benefit to this surgery. IF #1, where it did improve breathing, you have to ask yourself if you would later want the chin surgery for more aesthetic benefit. IF #2, no breathing benefit, you would then later need to explore the chin surgery for better breathing.
So it DEPENDS on what is WORSE to you to find out FIRST and whether or not you would want the chin surgery just for aesthetic improvement.
Would it be worse to you to find out first the tongue surgery did not improve your breathing and just resolved to having to get the chin surgery later because it didn't work OR would it be worse to you to get the chin surgery first and find out that although it improved your aesthetic, it did not improve your breathing.
To me, personally, I would go for the chin surgery FIRST, which has an aesthetic benefit, on the CHANCE that it could also improve breathing. It would be WORSE to ME to have the tongue surgery first and find out THAT did not improve breathing than to find first that the chin surgery did not improve breathing and especially so IF I would get the chin surgery ANYWAY for aesthetic improvement.
Keep in mind that it's a decision under UNCERTAINTY and the choice resolves to asking yourself what you would rather NOT find out FIRST.
Here are some links I found about tongue surgery and also a device to try which might help determine if the tongue is the culprit.
https://www.fauquierent.net/botcoblation.htm
https://www.verywellhealth.com/tongue-stabilizing-device-for-treating-sleep-apnea-3015243
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Thanks for your analysis of my situation Kavan.
Concerning aesthetic improvement i believe the surgery i discussed with my suegeon was the one here
https://www.google.com/search?q=genioglossus+advancement&safe=off&client=ms-android-samsung&prmd=ivn&source=lnms&tbm=isch&sa=X&ved=2ahUKEwiKpbiLltPiAhWOfH0KHUAWAr0Q_AUoAXoECA4QAQ&biw=360&bih=560#imgrc=i89Ljo5HdZ46mM
Where just a rectangle is cut out and brought forward. I'm not really expecting any improvement in aesthetics like a chin advancement.
That tongue device is actually a really good idea!. Not even my ENT told me about it. I brought one a few years ago before my MMA surgery, but it didn't help. Now i have been using it again the past 2 days and it works very well (post MMA) So excellent suggestion there! I guess that tells me the tongue is the culprit like you said. Pretty annoying though to not have all my airway problems fixed by MMA. I thought MMA was the ultimate solution. Maybe my airway is just that screwed up. Could be related to a connective tissue disorder I'm having checked out...a doctor told me a heart arrhythmia could be a clue to all this.
The tongue device also causes my teeth to press on my tongue. I can feel the pressure on my teeth, it might not be a great long term solution in terms of jaw relapse.
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Hey, I can get you some measurements on the weekend, I would appreciate your advice, I think we had a good medical article with healthy airway areas. I might dig that up.
By the way my old jaw surgeon is not even keen to do the genioglossus advancement unless I get a sleep study AND an ENT refferal. And my ENT is not backing the genioglossus advancement. And my jaw surgeon doesn't want to make any calls if the genioglossus advancement is appropriate for my issue.
I previously discussed the surgery with the jaw surgeon. It would be the surgery where a rectangle is cut below your lower teeth, which tries to capture where the genioglossus muscle is attached to your chin, and the rectangle is advanced forward and turned 90 degrees and screwed into your chin. I think I read somewhere the advancement is usually 6mm, or the width of your chin bone.
Does this improve chin aesthetics somehow? Does the labial fold become less pronounced or something? otherwise I can't imagine how the chin would look better?
Yes, there are some articles where airway meassurements are compared between OSA and and control group. Note that those studies does not say what meassurements healthy airways have. You can have small meassurements and have no problems, and big meassurements and have big problems. But there is a causality.
If you have your cbct raw files I would find it interesting to load it up in a dicom viewer and see what it looks like. On the study we've discussed earlier, the control group had a mean cross section area of 253+-76, while OSA had 159+-74. I can't see any area or volume meassurements on your pictures.
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Thanks for your analysis of my situation Kavan.
Concerning aesthetic improvement i believe the surgery i discussed with my suegeon was the one here
https://www.google.com/search?q=genioglossus+advancement&safe=off&client=ms-android-samsung&prmd=ivn&source=lnms&tbm=isch&sa=X&ved=2ahUKEwiKpbiLltPiAhWOfH0KHUAWAr0Q_AUoAXoECA4QAQ&biw=360&bih=560#imgrc=i89Ljo5HdZ46mM
Where just a rectangle is cut out and brought forward. I'm not really expecting any improvement in aesthetics like a chin advancement.
That tongue device is actually a really good idea!. Not even my ENT told me about it. I brought one a few years ago before my MMA surgery, but it didn't help. Now i have been using it again the past 2 days and it works very well (post MMA) So excellent suggestion there! I guess that tells me the tongue is the culprit like you said. Pretty annoying though to not have all my airway problems fixed by MMA. I thought MMA was the ultimate solution. Maybe my airway is just that screwed up. Could be related to a connective tissue disorder I'm having checked out...a doctor told me a heart arrhythmia could be a clue to all this.
The tongue device also causes my teeth to press on my tongue. I can feel the pressure on my teeth, it might not be a great long term solution in terms of jaw relapse.
I was thinking in terms of sliding advancement genio for aesthetic improvement. It does something in favor of breathing. That 'electrical plug in' genio does not look like it would do much aesthetically though. Glad the tongue device info was helpful. I just Googled around and found it. I guess the airway can be open enough but the tongue could block the air passing through it.
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I was thinking in terms of sliding advancement genio for aesthetic improvement. It does something in favor of breathing. That 'electrical plug in' genio does not look like it would do much aesthetically though. Glad the tongue device info was helpful. I just Googled around and found it. I guess the airway can be open enough but the tongue could block the air passing through it.
I've read articles saying that large sliding genio's do help breathing, in order of 10mm+. I've also read other articles that say sliding genio's aren't as effective as genioglossus advancement because they don't capture the genioglossus muscle, because it attaches to the chin closer to ones teeth.
I also came across this variation of a genioplasty called a mortized genioplasty. You might of heard of it.
https://ars.els-cdn.com/content/image/1-s2.0-S1010518207000546-gr1.gif
Which apparently gives you the advantage of capturing the genioglossus muscle as well as advancing the chin to give a better aesthetic. I'm not sure how common this technique is though. Also apparently whenever you make a cut to capture the genioglossus muscle you risk damaging the roots of the lower teeth, and they can potentially be lost. Just some things I thought I would share from my research.
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Yes, there are some articles where airway meassurements are compared between OSA and and control group. Note that those studies does not say what meassurements healthy airways have. You can have small meassurements and have no problems, and big meassurements and have big problems. But there is a causality.
If you have your cbct raw files I would find it interesting to load it up in a dicom viewer and see what it looks like. On the study we've discussed earlier, the control group had a mean cross section area of 253+-76, while OSA had 159+-74. I can't see any area or volume meassurements on your pictures.
The cbct is quite a few gigabytes in size Dogmatix. I can just show you screenshots.
Thanks for digging the areas up.
My narrowest area behind the tongue is 138mmsq
https://imgur.com/a/0RZk63a
It's something like 5.5mm anterior-posterior width at the widest part of the narrowest area behind the tongue shown.
I can't believe I had bimax and I still am below the OSA airways area avg! :o
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The cbct is quite a few gigabytes in size Dogmatix. I can just show you screenshots.
Thanks for digging the areas up.
My narrowest area behind the tongue is 138mmsq
https://imgur.com/a/0RZk63a
It's something like 5.5mm anterior-posterior width at the widest part of the narrowest area behind the tongue shown.
I can't believe I had bimax and I still am below the OSA airways area avg! :o
Just a note, these figures don't diagnose sleep apnea, it just shows some causality that was found in in that report. But as you also have problems it may justify your concern. Just want to say so you don't get stressed up by some numbers in a report, your experience is what's most important. But I agree, the anticipated 14mm advancement is significant and I've heard people with
OSA who only have about 10mm advancement with good result.
Do you have your cbct from before surgery so you can see the main cross section and volume there as well?
What dicom viewer do you use? The one I use don't offer support to automatically find min/max area and calculate the volume.
Yes I know, the files are large. Figured it shouldn't be a problem on Google drive or something. But it doesn't matter, seems like you find the interesting parts yourself.
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I've read articles saying that large sliding genio's do help breathing, in order of 10mm+. I've also read other articles that say sliding genio's aren't as effective as genioglossus advancement because they don't capture the genioglossus muscle, because it attaches to the chin closer to ones teeth.
I also came across this variation of a genioplasty called a mortized genioplasty. You might of heard of it.
https://ars.els-cdn.com/content/image/1-s2.0-S1010518207000546-gr1.gif
Which apparently gives you the advantage of capturing the genioglossus muscle as well as advancing the chin to give a better aesthetic. I'm not sure how common this technique is though. Also apparently whenever you make a cut to capture the genioglossus muscle you risk damaging the roots of the lower teeth, and they can potentially be lost. Just some things I thought I would share from my research.
That looks like what was referred to as 'balcony genioplasty' prior on this board by member; 'mcjawsurgery' who said Sinn would do for him but then he ended up having genio in Korea.