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Sleep Surgeon Question 57

Question 57- Dealing with CPAP problems following multiple surgeries

From: Jo

Hi,

I AM A 58 YEAR OLD MALE THAT HAS BEEN AT WAR WITH OSA FOR 15 YEARS. I HAVE HAD A UPPP AND SEPTUM SURGERY THEN A TONGUE ADVANCEMEN , THEN A HYOID SUSPENSION, 3 ROUNDS OF TONGUE SOMNOPLASTY AND MOST RECENTLY MMA (10MM ADVANCEMENT WITH COUNTER ROTATION ) WITH REWORKING MY NOSE AND TURBINATES.

I AM 7 WKS OUT AND MY SLEEP IS AS POOR AS BEFORE SURGERY. I HAVE BEEN UNABLE TO USE CPAP SINCE THE MMA DUE TO AIR MOUTH LEAKAGE. FULL FACE MASKS WONT SEAL DUE TO MOUTH OPENING EVEN WITH STRONG CHIN STRAPS. OBSERVING MY SLEEP AT HOME IS DESCRIBED AS STRUGGLING AND STRAINING TO BREATHE ALONG WITH THE SOUND EFFECTS. I HAVE ALL OF THE LONG OBSERVED SYMPTOMS DURING THE DAY OF OBSTRUCTION. I CAN ONLY SPECULATE THAT MY TONGUE IS STILL THE CULPRIT ALTHOUGH MY EPIGLOTTIS I SUPPOSE IS A POSSIBILITY.

SINCE I NO LONGER CAN USE CPAP TO HELP I HAVE TO TRY TO FIND RELIEF SOMEWHERE. SO FAR THE SURGEON SIMPLY WONT ADDRESS THE IDEA THAT I STILL HAVE OBSTRUCTION. I HAVE NEVER HAD ANY TITRATION TO FIND ANY SPECIFIC BLOCKAGE.

DO YOU HAVE ANY THOUGHTS ON WHAT TO EXPLORE AS A NEXT STEP? WHAT STRUCTURE CHANGE IS PERMITTING THE AIR FROM CPAP THERAPY TO FINDS ITS WAY OUT OF THE MOUTH?

THANKS

Response Provided by Dr. Kasey Li
June. 5, 2010

I would urge you NOT to have any further surgery. I very much doubt that it is your epiglottis or anything. I suspect that your airway is just very collapsible, despite expansion of the airway. Although many surgeons tell their patients that the advancement was good (>10mm),  I often find that it is not true....anyways, you might want to try an oral appliance along with CPAP. This approach could reduce CPAP pressure and improve the ease of air "finding" the path.

Good luck.
KKL