Has anyone out there had an MMA?

[SeattleBill]

Hey there hoseheads...I've been diagnosed with OSA since this spring. Since then I've tried and have been intolerant of Bipap. So, I have opted to improve my airway surgically in three phases. Phase one was a turninate reduction and septoplasty (went well no pain, stuffy nose for a few days, no big deal). Phase two was a tonsillectomy and UPPP (went well, less pain than I've read about; but not too bad, sore throat and modified diet for 7-10 days).

Phase three, however, is a forth-coming big deal planned for January. It is an MMA which is a maxillary and mandibular advancement operation with genioglossal advancement which offers a quoted 95% chance of a "cure" in the medical literature and by my surgeon. Neither of the previous procedures were intended to offer a "cure". They were intended to prepare my airway for either better results with Bipap or the MMA.

What I'm curious about is, has anyone out there had this lovely procedure yet? It is kind of a big deal, and I'm in search of more first-hand feedback about it. Thanks in advance. Bill

[Mr Mango]

Bill at first I thought you were playing it up but I went that way and almost had this operation. I was advised not too.

I went onto C- Flex and have no trouble with sleeping mostly. Would you not think trying a dental appliance before mandible surgery.

The pain of a UPPP is chicken feed to mandible surgery.

[<Seattle Bill>]

Thanks. I've actually tried almost everything without substantial relief. I'm not at all looking forward to the MMA; but I'm resigned to it because I recognize the morbidity of the long-term effects of OSA. Since nothing else has done the job and improved my sleep study, it seems like it is the thing to do. The UPPP wasn't bad at all for me...but I understand that is the exception. I've also been told that the MMA is paradoxically better tolerated than the UPPP. As for the expected ICU stay,etc...I believe that too will be managable (I work in the business and have insight into that angle of things).

I am curious though if there are other folks out there who have had an MMA and can fill in the gaps about the post-op recovery.
Thanks, Bill

[christinequilts]

I had my lower madible lengthened surgically when I was 16...also had my lower wisdom teeth out at the same time (they were in the way). My jaws were wired shut for 8 weeks but I really didn't have that much pain. I was in the hospital for a few day (late 90's...they kept you a lot longer then) but other then what ever they gave me via IV the first day I only took 2 doses of Tylenol #3. One was in the hospital to help me sleep after I had an allergic reaction to antibiotics the second was after I got home. Considering I was still recovering from a major knee surgery and had (unknowingly) ruptured a muscle in my knee just a couple of months prior to my jaw surgery I may have been more tolerant to pain then most but it really wasn't that bad. They lengthened my lower jaw by over 1 cm so it was pretty drastic- I had it done due to severe TMJ dysfunction/pain/migraines/etc. I do wonder now if it prevented me from developing OSA (I have CSA) as my sleep doc described my throat space as very small and he felt there was no question that I would have OSA just based on looking at my throat.

[snork1]

I am about to go into your "stage one" next week to get CPAP working.

The manible surgery was mentioned, but only reluctantly by the ENT, IF CPAP STILL DOESN"T WORK, after about 3 other stages in between, and time between that will be taken out to see if cpap is working.

Turbinate, septum and general sinus roter-rooter next week.

But pleeeeze let us know how the mandible work goes. I was certainly interested in hearing your history up to this point.

[<Seattle Bill>]

Thanks Christine, Mango & Snork!

To answer Snork and others looking down the barrel of any of these procedures. I'll lay out my surgical experiences...which is what in turn I'm looking for (thanks Christine)in anyone who has already had an MMA or mid-facial advancement.

It is at last resort and with reluctance that I've explored surgical options. Only after multiple product attempts and various permutations have I concluded that Bipap/Cpap/Autopap weren't a working solution for me. After consultations (curbside and formally) with 3 ENT surgeons and several sleep-pulmonologists, my three phase plan was developed.

I have seen the chronic result of folks with long-standing under/ or un-treated OSA, and the health ramifications are such that I'm determined to work on a "fix" or "cure" while my health is otherwise unaffected. If masks and machines worked, I certainly wouldn't look further.

I have completed my nose operations (really , not that big a deal...just a bad stuffy nose for a couple days), and a tonsillectomy with a UPPP. I was more concerned about these procedures than any other because of what I've read about them in terms of pain, discomfort, etc... For me,it wasn't too bad. The tonsillectomy was modified... a so-called capsule sparing tonsillectomy which is reported in the literature to be easier for pain and post-op bleeding. Also, the UPPP actually involves less "cutting" (actually more cautery) and "pexes" or tents up part of the sidewalls in a manner similar to what the new pillar devices do. Peri-op, my surgeon (and I believe most surgeons) prescribe steroids to ease the pain and inflamation. These work very well. There is a bad sore throat with at least a week of swallowing & eating limitations...and another week of progressive slow improvement in soreness and swallowing. I've been told that at least 50% or more pts. swear the UPPP is worse than the MMA (aka the bimax or the mid-facial advancement).

I may be reprieved in that I have one final sleep study to see if the nose and UPPP has improved my numbers enough to avoid more surgery. The odds are less than 25-30% that it will. (If anyone tells you that the odds with a UPPP are better, seek a second opinion as the current medical literature contradicts them). So, I've gone into this knowing I'll probably need all three phases; and no one has ever promised or advised differently.

I know of one other person here in Seattle whom I've talked to who has undergone all three operations in the same sequence. He is doing well and no longer requires Bipap with a "clean" sleep study. I am very catious though, and my goal is to contact others to see if they've had similar outcomes and experiences.

Thanks again. Bill

[<Duffy>]

You've probably already checked this out. The Stanford Medical Center website has information about the different phases of surgery. It's pretty informative.

[<SeattleBill>]

Hey Duffy,

Funny you should mention those guys ! I 've done everything else up here...but I'm going to them to get the MMA (I've been told they're the biggest, most experienced in this type of procedure on the West coast).

Bill

[snork1]

Seattle Bill, did you try CPAP again BETWEEN each phase of the surgeries to see if it started working finally?

That is pretty much my plan and the plan my ENT is pushing. Basically she is saying we are DONE, with the minimum amount of surgery to get CPAP working for me, and she seems in no rush to get from one stage to the next.

I am also driven to surgery out of desparation, after trying EVERYTHING.

[<SeattleBill>]

Hey Snork,

Yes I've tried BIPAP and some other tricks in the interim...and failed. Neither the nose surgeries and UPPP/tonsils have had a wonderful track record in the literature for improving sleep function. Notoriously bad, in fact...although for some, they have allowed better use of CPAP/Bipap at lower pressures with improved pt. compliance.

Therefore, for me if my sleep study isn't vastly improved, I'll be heading to Stanford to do my MMA. I anticipate that this would be the case. For yourself, I'd check with another ENT surgeon or center (if you're interested and driven to get more surgery)because most ENT surgeons are not cranio-facial / plastics specialists and/or aren't in centers specialized to support the type of reconstructive operations like an MMA. Most ENT training is limited to UPPP (which unfortunately, doesn't do a great job at "curing" OSA); and therefore, that is what they offer.

Beware that anything beyond a UPPP/tonsilectomy is "tiger country" ...that is, highly specialized and carries more morbidity. To minimize the morbidity, you might want to check the reputation/ numbers of procedures done by the surgeon and the center per year. I have passed up low-volume reputable local surgeons and hospitals to go to a big center for this reason.

Good luck, Bill

[verde]

Hi All,
Does anyone know of a good ENT in the Los Angeles area? I just had a UPPP and was not happy with the two ENT docs I dealt with. Sort of at a loss as to how to find another one. Any input would be appreciated!