Posted by sleepsurgeon on March 21, 2009 at 14:18:57:In Reply to: Re: Comments on MMA posted by DeSota on March 20, 2009 at 12:19:55:
Ethnicity is a major factor in many aspects of sleep apnea. Ethnic groups such as African Americans, Hispanics and Asians actually have a higher incidence and greater severity of sleep apnea as compared to Caucasians. There are also differences in the airway anatomy in terms of soft tissue and bone structural differences. African Americans actually DO have mandibular deficiency but the teeth portion are more protrusive (Hispanics and Asians also). It is called bimaxillary dental protrusion. In another word, the teeth portion of the jaw is protrusive but the chin portion of the jaw is deficient. Obviously, how a person’s facial esthetics is going to be postop is heavily dependent on how the person looks before the operation. Not all African American, Hispanic or Asian patients have bimaxillary dental protrusion,
I have done probably about 7 or 8 MMAs on African American patients but many more on Hispanics and Asians. There are a couple of ways to manage it. One way is to remove some teeth and pull back the front teeth to “retract” the profile either surgically or orthodontically. I prefer not to do it surgically because of a low, but DEVASTATING risk of sloughing off bone and teeth. It is safer to do it as a staged operation, i.e. MMA first and then surgery to “retract” the front part of the jaw to “soften” the profile months later. Orthodontic is a safer way and presurgical orthodontia is probably the best way but it takes months and many patients simply cannot wait that long. Postsurgical orthodontia is always possible and is the way I chose most often.
I tried to answer the question as simply as possible as there are other specific issues with specific anatomy that I will not be able to go into as all patients are different and it is hard to make general statements.
- Re: Comments on MMA DeSota 22:14 3/21/09 (0)