Reversing Maxillomandibular advancement surgery

[Zod]

Hello, I had MMA surgery and sliding gyno surgery on my chin for sleep apnea. Prior to surgery I had 23 apneas per hour (ahi) and post surgery a home study showed 1.5. I am awaiting results from an inlab study. Even though my apneas are resolved I continue to sleep just as bad as pre surgery. The home study indicated a high flow limitation (60%) which to my understanding may indicate respiratory arousals usually referred to as uars( upper airway resistance syndrome)

I suspect even though my surgery is considered a success as far as apneas go, I may still need to go on CPAP or bipap if in fact I do have uars.

Which brings me to my post, I am very disappointed in how I look now. Its not horrible, but definitely hurt my looks. My chin sticks out to far, it made my nose more bulbish due to moving the upper jaw and I feel it ruined my smile. If I look down a bit my face looks a little ape like. I'm not going to post pics at this time because I am not seeking opinions if people think it doesn't look too bad. Every time I look in the mirror I feel disappointment and regret.

What I want to know is if any one has info on getting this procedure reversed. I live in Ontario Canada and our govt health covers this surgery but I don't believe they cover it for aesthetic purposes. I also have a lisp now and some pain in my jaw.

I haven't spoke to my surgeon yet, but he seemed a little fed up with me complaining that I still sleep as poorly as before the surgery. He considers the surgery a success based on the home study in spite of the high flow limitation. I say this because I'm expecting him to be resistant to the idea of me reversing the procedure.

Does anyone know if in Ontario they will cover reversing this procedure based on the above? I'm also afraid they'll say no as that would be returning me to an apnea state. They may say it would be counter to my health.

My thought is again, I'll have to return to using a machine anyway so I just want my old face back. Anyone who has been through this surgery knows it's pretty tough so I don't say this lightly going through it again. I've thought about it daily and I know I want to do it.

Also, time isn't on my side. I had the surgery when I was 49 last year and I'm now 50. My understanding is they normally recommend this surgery for less than 50 years of age.

Also, I couldn't find much on risks of doing a second surgery. The surgeon fee was a few grand but the surgery itself covered by Ontario health is quite expensive. I couldn't find an exact amount but I've read 50-75k.

If anyone has any info on what I should say that would increase the likelihood of them undoing the surgery it would be greatly appreciated.

[Zod]

Sorry I meant to say i had the surgery 11 months ago so I don't think there is much swelling left.

[snapdresser]

I’m really sorry to hear about that, Zod. I had the exact same surgery for the exact same reason. I first met with a top orthognathic surgeon, who proposed 2 possible treatments: 1 where both jaws were pulled pretty far forward, and another where they weren’t pulled back quite as far per his “aesthetic eye” as he put it. That surgeon was too expensive so I found another, but her surgical plan was to advance my jaws quite a lot, more like Option 1. I had to research and send her studies showing that even a mild advancement yields good results. I can PM you that study if you like. The “rule of thumb” IIRC is a 1cm advancement of the maxilla to treat sleep apnea, and mandible to match, which ends up being huge aesthetically for many people. The point is, you might consider getting things moved back a few mm instead of a complete reversion to the original jaw placement.

That said, looking forward, have you considered UPPP surgery? Some US insurance companies require it before they’ll approve orthognathic surgery. It has potential for some pretty bad side effects, but perhaps it’s worth considering in your case. I’ve heard it works great for some people with a high, fleshy palate.

Good luck, and sorry again to hear about this battle you’re going through.

[Zod]

Thx for the reply. I've read about uppp and the success rate and pain concerns me. I think I'm accepting the fact that CPAP will be in my future. The inspire surgery has my interest.

Did the surgery work for you? Were you pleased with the outcome?

I haven't spoke to my surgeon yet but I can just imagine he'll be like 'hell no' and just trying to formulate a plan to convince him.

[snapdresser]

To be honest it didn’t do the job completely. I still had chronic nasal congestion afterwards so I still had to breathe through my mouth sometimes at night. My ENT said it was inflammation so I got allergy shots and went to see an ENT plastic surgeon who did a turbinate reduction, correction of a slightly deviated septum, and a cartilage spreader about a month ago. I’m still healing up but it seems to have improved.

[Zod]

I wanted to message you directly but couldn't figure it out. Hope you see this. I would like those studies on less movement still having good effects. Also, how much did you end up having yours moved?

[snapdresser]

Hi Zod, here’s the study: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1312227/

I don’t think you can PM people on here right away. You have to be some sort of super-confirmed user or something.

I don’t recall exactly how much I was advanced. It’s probably in my old messages on here. 5mm for the maxilla and mandible a bit more to match sounds right.

[Zod]

Glad you saw my message here. Thx very much for the link.

[snapdresser]

Sure thing!