6 month post-MMA update
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6 month post-MMA update

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Posted by dirtywater on July 14, 2008 at 22:32:12:

Hi all,

I had an MMA/GA (double-jaw surgery) back in January 2008. For past reference my 3 day post-MMA update is here:
http://www.sleepnet.com/noncpap23/messages/140.html

My 2 week post-MMA update is here:
http://www.sleepnet.com/noncpap23/messages/179.html

I have made a full recovery from the MMA. I am chewing fine and don't have any pain. The feeling is returning in my chin and lower lip; it's been very tingly for the last couple of months, which is a bit uncomfortable. But this is a good thing because it means the nerves are growing back.

Now for the bad news. After I tapered off the narcotic painkillers and stopped propping myself up in bed, my sleep got worse and the apnea seemed to return. This implies that the MMA did not help me much, if at all, and that the apparent post-surgical improvement that I reported earlier was actually due to my propped-up sleeping position. I have tried propping myself up in bed again, but I just can't seem to sleep in that position without the drugs to knock me out :-)

I had a followup sleep study 4 months post-op which confirmed that I still have obstructive apnea. I don't have the studies in front of me, but from memory I think the highlights were:

6/2005: RDI 30, min O2 87%. Diagnosis: OSA
11/2007 (pre-surgery): RDI 17, min O2 83%. Diagnosis: OSA
5/2008 (post-surgery): RDI 19, min O2 85%. Diagnosis: OSA

I think the 2nd and 3rd studies actually under-represented my RDI, because I remember waking up from those studies feeling abnormally "refreshed." At home I often wake up feeling much worse. I have a recording pulse oximeter that I use at home and it shows that my O2 saturation sometimes gets down to the mid 70's.

My pulmonologist at the sleep clinic didn't have much advice. The surgeon who did my MMA was stumped. I had a consultation with Dr. K. L. at Stanford yesterday, but it was a bit underwhelming. He told me a bunch of things that he thought would *not* help me (such as a uvuloplasty or a genioplasty), but he could not offer a definitive diagnosis or a strong recommendation for any particular surgery. He said basically my options are to re-titrate on CPAP/autopap, have a revision MMA, or have a pharyngeoplasty.

I'm going to experiment w/ the CPAP and see if perhaps a lower pressure will work for me now that I have had the MMA. I'm also going to see a pulmonologist in Boston who has looked at my sleep studies and thinks my apnea is actually mixed, and not purely obstructive. He has some sort of experimental machine that mixes carbon dioxide into the air that the CPAP delivers. I think the idea is that by mixing in CO2, you can avoid central apneas as you raise the CPAP pressure.

Another avenue of investigation is sleep endoscopy. The idea is to induce sleep with anesthesia, then try to locate the site of obstruction using endocsopy/laryngoscopy. Dr. K. L. told me doesn't believe in this technique, but I suppose it can't hurt to try. There's a doctor at UCSF who's doing some research with sleep endoscopy, so I'm going to try to be one of his guinea pigs.

Jeremy

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