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3 weeks MMA post op
#1
Hi guys,   I'm a nubie...
51 years old with big time OSA RDI in mid  60s.. Was having mild success with Cpap,  however,  felt like I wanted to improve things and did not want to be obligated to cpap as I got older.... had some very good recommendations for MMA surgery.   Did some research and pulled the trigger for Stanford.   Dr Liu.
Stanford, as Im sure most of you know is basically the gold standard for sleep medicine,  so for me this was the obvious choice.

Its a major deal and the first 10 days were very difficult for me with some major swelling difficulty breathing and not much sleep....

Im three weeks in now and I feel the airway is much improved.  I am sleep in 4-5 hours at a time with good dreaming (hoping that improves with time)

My main issue now seems to be blocked nasal and sinus on right side.. I would say this is at least moderate if not severe.... has anyone else had this issue?
Starting to wonder if this could be permanent.

Advice/comments/help  very appreciated.
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#2
You're in luck! I had MMA surgery last year, and have been dealing with the same sinus issue for months (i.e. my left nasal cavity always blocking up at night), and have it figured out now. The first thing I tried was steroid sprays, which gave me maybe 5% relief. Next I tried doing daily neti pot/nasal irrigation which helped a bit more, but the problem still remained. Steroid sprays + neti pot was too much as it dried my nasal cavity out (even with a humidifier), and made the problem worse. Last week I saw an otolaryngologist/ENT who did a CT scan of my sinuses and saw signs of chronic inflammation/infection in my left maxillary sinus (the one that was blocking up). He gave me a course of antibiotics to treat the inflammation and I've gotten a near 100% improvement. He thinks I'd benefit greatly from sinus surgery (either balloon sinusplasty or functional endoscopic sinus surgery), so I'm going to get that done soon. He also postulated that the screws/plates from the LeFort 1 ostoestomy portion of the jaw surgery were exacerbating the sinus inflammation. The screws actually go inside my left sinus cavity: http://imgur.com/a/94oQN. I emailed my jaw surgeron asking him if I should get the screws/plates removed, and this was his response:

"The screws are pretty inert and seldom cause trouble.  Patients who develop sinus
problems after Le Fort I osteotomy usually have problems with drainage because the
normal respiratory epithelial membrane can be replaced and heal with squamous
epithelium; consequently, the mucous produced in the normal sinus is not naturally
expelled from the osteum which is not actually at the bottom of the sinus...that is
to say, the mucous blanket must move uphill, but can't.  However, if your sinus
surgeon feels that the hardware is at issue, it's really an easy operation to remove
them, and I would be happy to do that.   Your maxilla is well healed and removal of
the screws and plates will in no way weaken your jaw or affect your bite."
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#3
Awesome!   Really glad to hear you found a course of action!   Question - how's your sleep been since the surgery?   Has the sinus problem hurt your sleeping.
I also have some pressure on my ear - feels like it wants to pop - do you think that is part of the sinus issue?
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#4
(03-15-2017, 03:02 PM)Steverino Wrote: Awesome!   Really glad to hear you found a course of action!   Question - how's your sleep been since the surgery?   Has the sinus problem hurt your sleeping.
I also have some pressure on my ear - feels like it wants to pop - do you think that is part of the sinus issue?

Yes absolutely it has hurt my sleeping. My sleep has fluctuated between amazing and very bad (tossing and turning all night) due to the sinus congestion. I had/have UARS so I'm very sensitive to airway resistance. Now that the sinus issue has been mostly addressed (as much as possible without surgery) I feel like I'm experiencing the "true" results of the MMA (i.e. sleeping through the entire night and feeling completely refreshed). Since you're only 3 weeks post-op, it could be the case that your problem is temporary and caused by swelling.

Re: ear pressure, this is normal during jaw surgery recovery.
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#5
Thanx your imput is  much appreciated.
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#6
Just wanted to update this thread in case anyone searches for it. I went ahead with my nasal surgery (turbinate reduction via submucosal resection with microdebrider and outfracture, balloon sinusplasty on all sinuses except ethmoid which needed a microdebrider, and a Latera implant for internal/external valve collapse) and my symptoms of nasal blockage are gone now. In addition, one my surgeons for another sleep surgery I did last month (tongue-tie release & labial frenuloplasty) just published a paper at Stanford University that says around 20% of MMA patients require nasal/sinus surgery + hardware removal due to changes in the sinuses and nasal region: https://www.ncbi.nlm.nih.gov/pubmed/28417661

It's been a long and arduous journey figuring this all out on my own so hopefully anyone that has a similar or the same problem after MMA sees this thread.
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#7
Thanks for reporting back!  I am sure this will help someone.
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#8
Sounds brutal! Would you do it again, and are the results worth it?
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#9
(07-27-2017, 07:13 AM)Sleeprider Wrote: Sounds brutal!  Would you do it again, and are the results worth it?

I'd do everything over in a heartbeat. I get consistent deep sleep now and feel way better than I ever felt on CPAP. However if I had to do it over with the knowledge I have now, I would've gone directly to Stanford and asked them to give me "the works", rather than going to separate surgeons via my own research.
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