Still tired and sleepy after MMA

[Picollo30]

these past few days i notice that i'm becoming very tired and sleepy throughout the day, even today i was in a reunion and i noticed i dozed off, had to take a coffee so i could stay awake, which is odd because in the first week i would sleep great. maybe something relapsed?

I'm afraid of using cpap because my whole face is sore because of the MMA. Weird condyle and jaws pains too.

I had a 7 mm bsso advancement with CCW rotation, and a lefort 1 with rotation and advancement (i dont know how much it was advanced). Airway enlarged from 4.4mm to 13.8 mm, maybe that's not enough?

I dont have a deviated septum as i had a septoplasty 3 years ago. I dont understand what's going on, my bite is off after surgery, i have facial pain, clicks and it hurts when i try to open my mouth (pain in condyles and jaws).

My next appointment with the surgeon is only in November, so i dont know what to do now. I want him to know that the surgery is really not working, i dont know if its because he didnt do the sliding genio, maybe it has influence but he said its cosmetic.

Was this a waste of time and effort? If it was today i wouldnt do it, i would say until now this wasnt worth it for me.

[Peter6789]

these past few days i notice that i'm becoming very tired and sleepy throughout the day, even today i was in a reunion and i noticed i dozed off, had to take a coffee so i could stay awake, which is odd because in the first week i would sleep great. maybe something relapsed?

I'm afraid of using cpap because my whole face is sore because of the MMA. Weird condyle and jaws pains too.

I had a 7 mm bsso advancement with CCW rotation, and a lefort 1 with rotation and advancement (i dont know how much it was advanced). Airway enlarged from 4.4mm to 13.8 mm, maybe that's not enough?

I dont have a deviated septum as i had a septoplasty 3 years ago. I dont understand what's going on, my bite is off after surgery, i have facial pain, clicks and it hurts when i try to open my mouth (pain in condyles and jaws).

My next appointment with the surgeon is only in November, so i dont know what to do now. I want him to know that the surgery is really not working, i dont know if its because he didnt do the sliding genio, maybe it has influence but he said its cosmetic.

Was this a waste of time and effort? If it was today i wouldnt do it, i would say until now this wasnt worth it for me.

Can you get your airways checked (x-ray, computer analysis)? Your surgeon should be able to show you before and after measurements.

Can you get your sleep checked by polysomnography or sleep lab?

Sliding genio, as far as I know, might help in OSA as it can strech your neck a little.

[thinkingme]

Bro i think its to early for regret or something. Ur nerves ur bones are regening now u can feel weird. I dont get jaw surgery but i remember i read this. Generally after 1 month everyone feel great if there is no complication. Just wait 2 week more and listen ur surgeon. Everything will be great.

[strongjawman]

Did the surgeon not explain all measurements of advancement?

[JimmyTheGent]

these past few days i notice that i'm becoming very tired and sleepy throughout the day, even today i was in a reunion and i noticed i dozed off, had to take a coffee so i could stay awake, which is odd because in the first week i would sleep great. maybe something relapsed?

I'm afraid of using cpap because my whole face is sore because of the MMA. Weird condyle and jaws pains too.

I had a 7 mm bsso advancement with CCW rotation, and a lefort 1 with rotation and advancement (i dont know how much it was advanced). Airway enlarged from 4.4mm to 13.8 mm, maybe that's not enough?

I dont have a deviated septum as i had a septoplasty 3 years ago. I dont understand what's going on, my bite is off after surgery, i have facial pain, clicks and it hurts when i try to open my mouth (pain in condyles and jaws).

My next appointment with the surgeon is only in November, so i dont know what to do now. I want him to know that the surgery is really not working, i dont know if its because he didnt do the sliding genio, maybe it has influence but he said its cosmetic.

Was this a waste of time and effort? If it was today i wouldnt do it, i would say until now this wasnt worth it for me.

I read that a genioplasty can also move the tongue forward to increased airway space.  Im surprised he didnt do that for you. 

[Lazlo]

if your airway is definitely enlarged to 13mm youre in the normal range and yes it should make a huge difference so get it checked again.

Sleep is also a complex phenomena so there may be a lot of other factors determining how much rem sleep you're getting.

have the size of the airway checked again pronto. and even though you may not have a deviated septum you might still have quite obstruction in your sinus such as i forget what they're called enlarged "poplars or popylrs" or something --basically like tissue that slightly obstructs your nasal passage.

[Picollo30]

if your airway is definitely enlarged to 13mm youre in the normal range and yes it should make a huge difference so get it checked again.

Sleep is also a complex phenomena so there may be a lot of other factors determining how much rem sleep you're getting.

have the size of the airway checked again pronto. and even though you may not have a deviated septum you might still have quite obstruction in your sinus such as i forget what they're called enlarged "poplars or popylrs" or something --basically like tissue that slightly obstructs your nasal passage.

yes i've seen the new ceph with my own eyes, doctor did a before after airway comparison between cephs, and i've seen that the airway is bigger. about the sliding genio he told me it was a cosmetic procedure and NHS wont pay for that, which is damn hard for me to believe, because i've seen sleep apnea cases treat with sliding genio as well. I still have the CPAP machine at home, but since the surgery i havent used it as my face is all sore and i think the full mask puts pressure on the jaws and mouth. I have an appointment with the pulmonologist in 31 may and i know she will be pissed that i'm not using the machine.

As for the nose when they did the septoplasty they also removed the hump on bridge, removed a polip and did turbinectomy as well.

I already called the hospital about getting a ceph copy on cd or something and they said they would hook me up with a copy so i will post it here.

Next appointment is in November 2016, but if i'm not better i will probably call him or see him in his private clinic. I want to know what's going on and the reason why he didnt do the sliding genio, which for me was one of the most important things, to give me a stronger profile.

About the pain in the ears (its more like a burning sensation inside the ear) and condyles i notice that it's caused by the rubber bands or the position they are in, and the pain is driving me crazy, i'm taking Advil for the pain, Nimesulide, an anti inflammatory and Adalgur, a muscle relaxant for the jaws that reduces spasms and while i dont have that many spasms i still have ear and jaw pain.

Do i have to wait more 2/3 months to see all the pain gone and to have more jaw strenght/mobility?

[Tezcatli]

yes i've seen the new ceph with my own eyes, doctor did a before after airway comparison between cephs, and i've seen that the airway is bigger. about the sliding genio he told me it was a cosmetic procedure and NHS wont pay for that, which is damn hard for me to believe, because i've seen sleep apnea cases treat with sliding genio as well. I still have the CPAP machine at home, but since the surgery i havent used it as my face is all sore and i think the full mask puts pressure on the jaws and mouth. I have an appointment with the pulmonologist in 31 may and i know she will be pissed that i'm not using the machine.

As for the nose when they did the septoplasty they also removed the hump on bridge, removed a polip and did turbinectomy as well.

I already called the hospital about getting a ceph copy on cd or something and they said they would hook me up with a copy so i will post it here.

Next appointment is in November 2016, but if i'm not better i will probably call him or see him in his private clinic. I want to know what's going on and the reason why he didnt do the sliding genio, which for me was one of the most important things, to give me a stronger profile.

About the pain in the ears (its more like a burning sensation inside the ear) and condyles i notice that it's caused by the rubber bands or the position they are in, and the pain is driving me crazy, i'm taking Advil for the pain, Nimesulide, an anti inflammatory and Adalgur, a muscle relaxant for the jaws that reduces spasms and while i dont have that many spasms i still have ear and jaw pain.

Do i have to wait more 2/3 months to see all the pain gone and to have more jaw strenght/mobility?

These rubber bands hurt as hell, even without jaw surgery, I used bands with my braces and they hurt.

I wouldn't use the CPAP mask, it is normal to feel tired as among other things your body is recovering from surgery, just drink coffee lol

[molestrip]

I'm afraid of using cpap because my whole face is sore because of the MMA. Weird condyle and jaws pains too.

Wait at least 4mo for bone to fully heal, otherwise CPAP could affect the results. Sucks about the condyle and jaw pains but they're common, especially with large advancements.

I had a 7 mm bsso advancement with CCW rotation, and a lefort 1 with rotation and advancement (i dont know how much it was advanced). Airway enlarged from 4.4mm to 13.8 mm, maybe that's not enough?

That's not an MMA technically. Your airway changes don't make sense given the advancement, should have been less. 13.8mm is certainly sufficient on a normal person not to have sleep apnea, however there's some debate as to whether too much is a good thing. Sometimes if over advanced the lateral walls can start collapsing. Sleep apnea isn't just a hard tissue deformity but also a soft tissue one and surgeons don't really correct everything. That's why it's a gamble. You can look at minor procedures next, GA, hyoid advancement, UP3 variants, etc. However, in your case I would call it a day and just use CPAP and maybe revisit surgery in a few decades once technology has improved.

I dont have a deviated septum as i had a septoplasty 3 years ago. I dont understand what's going on, my bite is off after surgery, i have facial pain, clicks and it hurts when i try to open my mouth (pain in condyles and jaws).

Joint problems should settle with time. It's disconcerting when it happens. I hope it doesn't happen to me. Relapse is not uncommon but at 7mm, I wouldn't think you should have it. That's considered a safe and stable advancement. Surgeon may have made an error in positioning the condyle during surgery, not all their fault there's not good solutions today for checking it really. May take a few months but the condyle should remodel to the new position. Worst case, you'll need revision surgery to reposition it. In the mean time, take it easy to avoid damaging the disc too much.

Was this a waste of time and effort? If it was today i wouldnt do it, i would say until now this wasnt worth it for me.

That's the nature of surgery, a gamble.

[JimmyTheGent]

if your airway is definitely enlarged to 13mm youre in the normal range and yes it should make a huge difference so get it checked again.

Sleep is also a complex phenomena so there may be a lot of other factors determining how much rem sleep you're getting.

have the size of the airway checked again pronto. and even though you may not have a deviated septum you might still have quite obstruction in your sinus such as i forget what they're called enlarged "poplars or popylrs" or something --basically like tissue that slightly obstructs your nasal passage.

I had a sleep study done and my ENT and a Neurologist were stunned to see that I never entered REM sleep.  They didnt have much to say about it either except that they were all shocked.  Is that a bad thing? I hear that can make you go crazy but an ENT said that was not true. 

[Dharma]

Sorry to hear about your sleep.  Given the size of your new airway you should be good to go--was the measurement taking at the most narrow space and where it was determined, pre-surgery, your problem was?  Sleep is very complicated and you have a lot of confounding factors.  I would give it some time to see what happens.   

That said, I'm 4 weeks out from MMA for sleep apnea and I think I'm sleeping pretty well (in terms of my breathing anyway).  My airway improvement was in the ballpark of yours. 

Best of luck!   

[molestrip]

PAS is but one measurement in OSA. Airway length matters, as does the nervous system, soft tissue compensations, minimum cross section, and probably other factors not yet identified. Your next step is to determine if you still have OSA, that is whether there are any apneas or hypopneas. Presumably you're cured and then you have another sleep disorder now. It's possible it's just a complication from untreated OSA before and it may normalize with time. But then REM sleep is pretty important so you'll want to investigate whether it's possible to treat it with medication in the mean time.