Maxillomandibular Advancement for sleep apnea in Toronto

[wantsleep]

Hi, first time posting here.

Are there any recommendations for good oral surgeons for MMA for sleep apnea in the Toronto/GTA or Southern Ontario area. I'm in Mississauga. There doesn't seem to be too many orthognathic surgeons in the area, let alone ones who specialize in sleep apnea.
If you've gotten an MMA for sleep apnea in Toronto or in the Southern Ontario/GTA area, who was it with and how successful was your treatment?

I am thinking of going with Dr. Caminiti at Crescent Oral Surgery since he primarily does orthognathic surgeries, but I haven't read anything about him doing MMA specifically for sleep apnea, but I imagine that the procedure is virtually the same as with for other indications but with a more aggressive advancement?

I'm also aware of Dr. Claudio Tocchio who used to work with Dr. Caminiti, who I've read is good, too, but again I can't find any accounts from sleep apnea patients. There is also Dr. Stephen KC Ho in Mississauga who actually specializes in sleep apnea, but I'm saddened and dismayed by the terrible reviews on ratemd.

I don't really have the means to travel abroad to get it done with someone like Dr. Kasey Li in Cali.

Also, how long do you have to wear braces for usually before getting MMA and how long does the whole process take from first consultation to finally getting the operation? Thanks so much in advance.

[Jbird]

I'm also on the path to get the MMA for sleep apnea. I just got my braces on. My teeth are straight but they want to expand it some. The ortho says at least a year in braces before surgery and then 6 months to a year after surgery. I too wish I could go to Kasey Li in California, but I'm in Texas so not practical. I have been told they may advance you more for sleep apnea, but everyone is different. My surgeon wanted to do the UPPP at the same time. Sorry, I don't know of any doctors in Canada. I bet there are some.

[ZiziOConnor]

From everything I've heard, Crescent Oral Surgery is the best in Toronto.

[wantsleep]

Thanks for the replies.

So to answer my own question after a little more research, it seems like Dr. Claudio Tocchio has the most positive online mentions that I've seen so far with a lot of recommendations at jawsurgeryforums and from blogs I've pulled while googling, followed by Dr. Caminiti at Crescent Oral. Dr. Tocchio seems to have the most experience in orthognathic surgeries in Southern Ontario. Both Dr. Tocchio and Dr. Caminiti do at least a couple of orthognathic surgeries every week from what I've read. They also used to be partners as I've mentioned.

Sort of found a case study and a glowing review from a patient of Dr. Tocchio's. If you know about the Something Awful forums, according to a poster there who had an MMA done with Dr. Tocchio back in 2011 for severe sleep apnea (65 to 70+ AHI), Dr. Tocchio's been doing MMAs for 30+ years. Same poster also had major retrognathia and had his lower jaw moved 11mm, upper jaw 5mm, a bilateral inferior turbinate resection (2/3), and a 2mm genioplasty at the same time. Operating time was 2.5 hours (!) with two surgeons. Cost was just above $4000 for the surgeon's time and hospital stay.

He mentioned that his snore was completely eliminated, no longer feels tired in the afternoon, and has no issues sleeping on his back. They also did a really beautiful job on his jaw and chin. He first mentioned post-surgery AHI dropped to 14 from 65, then it was from 70+ to under 10. He said his apnea was fixed and felt 100x better; O2 saturation is normal and doesn't need to be on CPAP to sleep. Overall, he was quite ecstatic with his results. His posts can be found in the Obstructive Sleep Apnea thread in the Goon Doctor subforum. Registration (10 bucks) might be required to read it.

Having read about his success, other recommendations on the web, and about Dr. Tocchio's experience, I'm pretty convinced to go with Dr. Tocchio for my MMA. I've already booked an appointment for a first consultation with Dr. Stephen Ho a couple of days ago, but as of right now, I am thinking that it might not be necessary.

[Krenee2690]

Wantsleep... you mentioned cost just above $4000, is that after insurance?

[wantsleep]

[quote="Krenee2690"]Wantsleep... you mentioned cost just above $4000, is that after insurance?[/quote]

Good question. That's before insurance, I'm sure. I remember asking both the director at Credit Valley Oral Surgery and the receptionist for Dr. Tocchio over the phone about the cost. IIRC at Credit Valley, it's like $5000 out of the pocket for the procedure with braces, and $1000 more if you're doing it without braces. When I asked the receptionist for Dr. Tocchio if it costs around $4000 to $5000, she said it was something like that.

[wantsleep]

Actually, the cost of $4000 was back in 2011. The loonie's ballooned since then. And there shouldn't be a $1000 difference between surgeons, I don't think, so it's probably something like $5000 with Dr. Tocchio as well. In fact, a post back in 2015 at jawsurgeryforums mentioned it costing $5000 from "one of the best jaw surgeons in Toronto." Don't know whom it's in reference to, maybe Dr. T or Dr. Caminiti? Also keep in mind that that's the cost excluding ortho treatment, which will be $5800 in my case.

[madblogr]

I'm happy it sounds like you've found your surgeon. I too am having jaw surgery for sleep apnea, 90+ AHI. Currently going through SARPE (finished expansion back in August) and MSDO (surgery coming up on 11/29) first then will get re-evaluated in Summer, 2017 after healing and some more alignment from braces. If AHI is still high then surgeon will move forward with MMA. So far with just the SARPE I'm noticing a big difference in breathing and sleeping. Still have to use CPAP due to part of the treatment plan until I get re-evaluated again. I'm hoping for continued positive outcome so I can stop using the machine at night.

[wantsleep]

Thanks. I'll likely end up getting it done with Dr. T, but I'm still going to get a consult with all 3 oral surgeons, I think. Wow, 90+ AHI is absolutely bonkers. Even though my AHI is only 30 and CPAP gets it down to below 5 AHI, I still feel pretty dead every day. I've had my bicuspids pulled when I was young because the orthodontist couldn't save them as they were coming in from above the central incisors.

I'm now wondering if having missing bicuspids contributes to a jaw anatomy that results in a compromised airway. I've read that it could and that, actually, it doesn't. I'm retrognathic, but my upper palate width seems to be pretty normal and my current orthodontist didn't mention anything about it being narrow. How's the recovery going for your SARPE? How long does it take to recover? Happy to hear that your breathing and sleeping seems improved with SARPE. But does that mean improvements with mouth-breathing, or with nasal breathing as well? Did they measure the widths of your airway?

[madblogr]

[quote="wantsleep"]Thanks. I'll likely end up getting it done with Dr. T, but I'm still going to get a consult with all 3 oral surgeons, I think. Wow, 90+ AHI is absolutely bonkers. Even though my AHI is only 30 and CPAP gets it down to below 5 AHI, I still feel pretty dead every day. I've had my bicuspids pulled when I was young because the orthodontist couldn't save them as they were coming in from above the central incisors.

I'm now wondering if having missing bicuspids contributes to a jaw anatomy that results in a compromised airway. I've read that it could and that, actually, it doesn't. I'm retrognathic, but my upper palate width seems to be pretty normal and my current orthodontist didn't mention anything about it being narrow. How's the recovery going for your SARPE? How long does it take to recover? Happy to hear that your breathing and sleeping seems improved with SARPE. But does that mean improvements with mouth-breathing, or with nasal breathing as well? Did they measure the widths of your airway?[/quote]

Interesting you mention this about your bicuspids. My lateral incisors came in behind my canines and incisors on the top which was probably one of the things that led to me having a narrow upper palate (~14mm at the 5's!). With SARPE we added 17mm more and my rear molars had also been pushed inwards due to impacted wisdom teeth. With SARPE, my width reached a total of 31mm and I think we've added a 2+mm now pulling the molars straight too. A saw somewhere an adult's upper width should be around 34-36mm.

Recovery from SARPE seemed to be pretty by the book lots of soreness, nose bleeds. A couple days of narcos and some Tylenol, then just narcos at night with Tylenol rest of the time, then finally no narcos and switched over to ibuprofen. By two weeks, I was released back to work and down to a 200mg ibuprofen as needed. Liquid foods at least the first few days and then soft foods (i.e. mash potatoes) the second week. I think third week I was already starting to eat canned ravioli and after that it just took experimenting with foods to learn what I could bear to chew.

As for the breathing, it has improved all the way around both via mouth and nasal breathing. I agree with another poster here on the board, it is like going from regular ceilings to cathedral ceilings. There is quite a bit more volume in the oral cavity and I'm guessing there was some gained volume in the nasal cavities as well above the palate since it got expanded. No measurements before the operation other than between teeth but I was lucky enough to meet up with an orthodontist which did his research on impact of teeth alignment on breathing. Also during SARPE surgery the surgery team quickly discovered I had narrow passageways as they were unable to intubate me nasally and had to do it quickly orally since my reserve air dropped off a cliff as soon as I went under.

[tgreen2017]

[quote=wantsleep post_id=488093 time=1479792911 user_id=28463]
Thanks. I'll likely end up getting it done with Dr. T, but I'm still going to get a consult with all 3 oral surgeons, I think. Wow, 90+ AHI is absolutely bonkers. Even though my AHI is only 30 and CPAP gets it down to below 5 AHI, I still feel pretty dead every day. I've had my bicuspids pulled when I was young because the orthodontist couldn't save them as they were coming in from above the central incisors.

I'm now wondering if having missing bicuspids contributes to a jaw anatomy that results in a compromised airway. I've read that it could and that, actually, it doesn't. I'm retrognathic, but my upper palate width seems to be pretty normal and my current orthodontist didn't mention anything about it being narrow. How's the recovery going for your SARPE? How long does it take to recover? Happy to hear that your breathing and sleeping seems improved with SARPE. But does that mean improvements with mouth-breathing, or with nasal breathing as well? Did they measure the widths of your airway?
[/quote]

Did you go through Dr. T, or do your MMA? I'm considering getting a MMA myself (instead of UPPP from an ENT) and would love to hear about other patients in Toronto.