Jaw Advancement to improve breathing

[Dogmatix]

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.

[kavan]

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

[PloskoPlus]

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.

[dammit_daniel]

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.

[kavan]

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.

[CCW]

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.

[Dogmatix]

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?

[dammit_daniel]

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.

[PloskoPlus]

There's a separate surgery for the hyoid bone.

[dammit_daniel]

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?

[JourneyToSerenity]

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.

[dammit_daniel]

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.

[dammit_daniel]

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.

[Dogmatix]

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.

[kavan]

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.