jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: jawsaw on September 02, 2015, 05:18:53 AM
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To people who underwent bimax advancement for sleep apnea: What are some some areas of your life where you saw improvement that you did not expect? What are some areas of your life that you expected improvement and the results exceeded expectations? Was there anything that you expected that did not manifest to the degree in which you would have liked?
eg) Improvement in memory, less back pain due to proper posture, improvement in skin, more social, greater feeling of wellbeing, more motivation, enunciation improvements, dream quality, anything, anything, anything.
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While I certainly could be counted as someone needing bimax for cosmetic and functional reasons, the reason for my surgery was sleep apnea.
Now I didn't even know I had slep apnea. I spent most of my adult life thinking I needed 9-10 hours of sleep because that was how I was.
As soon as my nose cleared after the surgery I was breathing better. I always felt like I had a restriction in my breathing.
Sleeping now ( nering 6 months post op) has been more refreshing. I wake up ready to go. I dream (meaning I remember dreams and this is something I havent done since I was a kid). I fall sleep better.
The cosmetic improvements were a huge extra plus of the surgery - very big. In fact, without the side benefit of the cosmetic aspect, I;m not sure I would have put myself through this although the sleep benefits were worth it - it just takes an over whelming set of benefits to allow yourself to be subjected to this surgery - its not small ordeal.
The downside has been realted to nerve issues and changes on my mouth structure that resulted in difficulty in relearning to talk and eat properly and without pain.
Proper posture - interesting question. I havent noticed anything there but I may be standing a bit more tall since the surgery....
Social aspects are notcieable. Cosmetically - it would seem the world is reacting to me differently and I to the world. Sleep related, I have more energy in the day for social activities.
Speaking has been more difficult. I think I am still recovering in that respect. So - more time is needed.
I have some lip incompetence. This is bothersome and since one of my goals was not to have to manage my jaw to cover my teeth all the time - this hasn't been resolved as I have to force my lips together. I just want to close my mouth and relax around others. Having to force my lips closed prevents this. I envy those who can just relax their face and exist without worrying about looking stupid. It detacts from my inclination to be social. I'm still hiding from the world.
Mouth breathing - I don't think I'm doing that much at all. That is a big improvement. I'll have to video myself at night to check but I can't think of any days were I am waking up with a dry mouth or my lips being stuck on my gums from drying out. That should help with the health of my gum and teeth.
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I am just 4 weeks post op. Maxilla moved forward 9 mm down 4.5-5 mm, lower moved forward 14mm. Still splinted hope to have it removed next week. My sleep is way improved and I also dream like crazy. I joke that my dream life is more enjoyable than my waking life. Lol!! Still have residual swelling and lost 15 lbs. so still don't have final cosmetic effects yet. I think that my expectations were a little high. I certainly have more teeth showing when I smile but pretty much look as I did prior. As others have said on this forum, it isn't going to make you a whole lot different just a better you. I guess all the years that I analyzed what I wanted out of some kind of jaw surgery I imagined a face with overall bigger more robust bone structure and teeth. I let myself imagine more than what was realistically feasible. Over all I am happy with the results.
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What are the nerve issues? I have a big tongue for my mouth so I'm expecting improvement in these areas. Honestly, the biggest adjustment is going to be the lack of wisdom teeth. That's really screwed me up. I've spent the last 15 years of my life only chewing with those. Glad to hear you all are happy with the aesthetic change. Saw my simulation and it looked good to me too. However, I know too much for my own good now lol. I know I'm not getting an ideal face. My ramus needs to drop ~5mm and my gonial angle normalized. Not sure my mandible even needs advancement, plenty of space for Wisdom teeth suggests not but the rotation alone would add a few mm of space to my airway and make me normal. Seems the only guys who can fix this the right way now are in Tokyo. A bit far to travel.
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You should see the xrays I posted depicting how much bigger my airway became:
http://jawsurgeryforums.com/index.php/topic,4737.15.html
To summarize it all, I can finally breathe now with my mouth closed.
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I had both pre molars and wisdom teeth removed with braces as well when younger and never had a problem chewing. I think that after orthodontics you will chew fine.
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Reassuring to hear :) I just need to find a way to get through this and make sure the surgeons don't screw me up.
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^seriously.
Also I've read some stories online where people are treated differently after JS. this is probably more related to people who had great outcomes.
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Terry....
Its no joke. I've noticed a difference in how people look at me and my braces are still on....
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What are the nerve issues? I have a big tongue for my mouth so I'm expecting improvement in these areas. Honestly, the biggest adjustment is going to be the lack of wisdom teeth. That's really screwed me up. I've spent the last 15 years of my life only chewing with those. Glad to hear you all are happy with the aesthetic change. Saw my simulation and it looked good to me too. However, I know too much for my own good now lol. I know I'm not getting an ideal face. My ramus needs to drop ~5mm and my gonial angle normalized. Not sure my mandible even needs advancement, plenty of space for Wisdom teeth suggests not but the rotation alone would add a few mm of space to my airway and make me normal. Seems the only guys who can fix this the right way now are in Tokyo. A bit far to travel.
Molestrip,
Can you elaborate some on the bold face highlighted comment ? PLEASE do not take this as a critical comment. It is absolutely not. From your posts, you have obviously spent an enormous amount of timing studying this subject !
However, either, that comment presumes that you have self-diagnosed exactly the details of the surgical procedures that need to be done - - and then you have determined that no one in North America can do those or that combination of procedures - -
Or else, some surgeon with whom you have consulted has told you that you need that surgery matrix and that it can only be done in Tokyo?
So I would like to hear some elaboration on the background for your conclusion in this regard.
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That was for the modified inverted-L osteotomy (http://www.joms.org/article/S0278-2391(08)00264-4/abstract), which is just a safer variant of BSSO it sounds like. The HSSO is more interesting, which was recently studied (http://www.ncbi.nlm.nih.gov/pubmed/23260982) in the UK with seemingly good results. It allows lengthening of the ramus with modification of the gonial angle. What it doesn't permit is lengthening of the mandibular body. So... it's tailor made to patients like me and there's probably not a lot of us lol. Very steep mandibular planes are almost always accompanied by short mandibular ramus and bodies. It'd be a useful tool for others too I think in conjunction with another osteotomy but no one wants to research that because it's not that much better for those cases. Also, bony overlap probably isn't as good. I noticed MGH has been doing DO of the ramus to lengthen it for ICR cases, I wonder if the same technique would be useful in a case like mine. Sometimes it's internal, sometimes it's endoscopic external.
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That was for the modified inverted-L osteotomy (http://www.joms.org/article/S0278-2391(08)00264-4/abstract), which is just a safer variant of BSSO it sounds like. The HSSO is more interesting, which was recently studied (http://www.ncbi.nlm.nih.gov/pubmed/23260982) in the UK with seemingly good results. It allows lengthening of the ramus with modification of the gonial angle. What it doesn't permit is lengthening of the mandibular body. So... it's tailor made to patients like me and there's probably not a lot of us lol. Very steep mandibular planes are almost always accompanied by short mandibular ramus and bodies. It'd be a useful tool for others too I think in conjunction with another osteotomy but no one wants to research that because it's not that much better for those cases. Also, bony overlap probably isn't as good. I noticed MGH has been doing DO of the ramus to lengthen it for ICR cases, I wonder if the same technique would be useful in a case like mine. Sometimes it's internal, sometimes it's endoscopic external.
Ah... got it. Thanks.
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Interesting responses!
Seeing people react to you differently must be quite a trip. I could only compare it to what an overweight individual goes through after losing their excess body mass, and that is something I am fortunate enough to have never experienced. I am nervous about looking different, but after reading about people who have had this procedure it feels good to know that the vast majority of people think the change is for the better. Also I have sported facial hair since I have been able to grow it, so neither I or anyone else is all that aware of what my underlying facial structure is anyway. Mike Napoli of the Boston Redsox is a great pop-culture example of someone who had the surgery who has had a large improvement in their quality of life without looking that much different, due to the beard no doubt. Although I have not seen many post surgery pictures of the athlete juxtaposed with a pre surgery photo. My facial hair has become so ingrained in my identity that I doubt it will go anywhere after I have the surgery (estimated 3-4 months. My premolar gaps have about 3mm to go).
I have an inkling that I will be a much much happier person. Most of my life is spent in a mental fog or state of agitation, due to lack of sleep/constricted feeling in airway. Very rarely do I wake feeling well rested, but it does happen. When it does I feel like a completely different person. I say to myself "Ah, yes, THIS is how life is supposed to feel!". On thoes rare days I am incredibly productive and optimistic. Aside from those days I feel like I am just trudging through life waiting for the surgery, so I can feel normal everyday. I have to make sure to keep my expectations in check, but I'm pretty sure I will be super-human after this whole ordeal is over. I can not wait.
I hope some more people respond to this thread!
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I just got my surgery date! Its going to happen in early March! I had hoped that it would take place earlier in the year. Oh well. Four quick months till my face gets sliced, diced, and rearranged. How is everyone who had sleep apnea jaw surgery doing? Reality is hitting me and I want to hear from my internet orthognathic comrades.
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I'm 5 days post surgery. I had lefort 1, bsso, and a genioplasty. Here's my airway before.
You can see it's really pinched off.
[attachment deleted by admin]
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I just got my surgery date! Its going to happen in early March! I had hoped that it would take place earlier in the year. Oh well. Four quick months till my face gets sliced, diced, and rearranged. How is everyone who had sleep apnea jaw surgery doing? Reality is hitting me and I want to hear from my internet orthognathic comrades.
The first 3 days are rough, but then it starts getting easier. My wife has taken great care of me, which has helped a lot. The hardest thing I wasn't ready for is eating thru a syringe. It's harder and messier than I thought it would be. I would recommend practicing . What makes it so tough is that you can't close your lips and you have to tilt your head backwards, making it easy to choke. Luckily, its eggnog season, which is nice and thick and slow.
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Highly recommend getting a Vitamix which allows you to blend just about anything. I was using it multiple times a day :D
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I actually plan on getting a Vitamix! Good call! How is sleeping? Do you feel a lot better during the day?
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Also, for anyone who finds it interesting: After having bottom bicuspids pulled, my orthodontics are closing the holes and pulling my bottom front teeth back, giving me an overbite. I just measured the distance between top and bottom incisors. I have a 7mm overbite! And the holes have not fully closed yet. Keep in mind that when I had my braces put on my top and bottom teeth touched tip to tip. Wow my bottom teeth must have been sooo angled. So If the standard maxillary advancement for OSA is 10mm, they will be advancing my mandible close to 2cm?! Wild stuff. I am going to look so different. Scary.
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No one advances the maxilla 10 mm.
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No one advances the maxilla 10 mm.
Not true but probably true in this case. You tend to see it more in syndrome cases but grafting is required for stability.
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Dr Posnick's treatment plan included a 10mm advancement of my maxilla. Isn't he an orthognathic God? I'm not a syndrome patient not do I resemble one.
Also I read that a pioneer in the field: Dr Kasey Li ONLY does large advancements.
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Also, you are correct about grafting. I was told a cadaver bone would be used. I didn't go with Posnick because if I wanted that much debt, I'd go to an Ivy.
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Hey jaw surgery friends! I think its safe to say the bicuspid gaps are finally closed. I had the teeth pulled in the end of April. Eight months later the gaps are closed and I have an extremely annoying overbite. Ah, just counting down the days.
To anyone who would find the information useful: The teeth pulling was virtually painless. Same goes for the recovery. The process of pulling the teeth back was minimally uncomfortable. Most of the discomfort came from the wire poking out of the back molar bracket and stabbing my cheek as the spaces became smaller between orthodontist appointments. Initially the change in the shape and size of my mouth was very noticeable and bothersome. I developed a slight lisp. Ironically, as time went on and the space in my mouth became smaller it became easier to deal with. People adapt, we are pretty good at it. Also the lisp minimized as I became accustomed to the new shape.
Now here comes the annoying part. Now that the space in my mouth has decreased substantially, there is little space left for my tongue. I think I mentioned before, but I'll say it again; the only way to have a comfortable mouth posture is with my tongue sticking out over my bottom teeth. My mouth is closed but instead of my bottom teeth touching my bottom lip, its my tongue flapped over my bottom teeth that touches my bottom lip. Google "Lil Bub" if you cant picture what I mean (or just google it anyway because: cute). In waking life this is annoying but tolerable. It is not so tolerable at night while I try to sleep. My tongue is pushed back, making my airway even smaller than it initially was. The quality of my sleep is most definitely suffering.
But alas there is light! 12ish more weeks!