Hello Guest, Welcome to Apnea Board !
As a guest, you are limited to certain areas of the board and there are some features you can't use.
To post a message, you must create a free account using a valid email address.

or Create an Account


New Posts   Today's Posts

What type of surgeon can fix neck airway, so don't need cervical collar?
#1
Question 
What type of surgeon can fix neck airway, so don't need cervical collar?
This year I'm making it a goal, before I leave my current company, to get some medical issues fixed while I have insurance. 

I no longer want to use a cervical collar to keep my neck straight at night. It is too restricting with all the other gear. I also use AirCurve Bi-level, FF mask, ResMed "Narval CC" dental appliance to move my jaw forward. And a chin strap to help keep mouth from opening. Although I still wake up with a super dry mouth some nights. 

If I don't wear the collar, I get major obstructions, dozens of 20-45sec long within a few minutes. This has caused my heart to go into AFIB in 2017 and in Bigeminy in 2018. Also any minor leaks also can cause these issues. I have to strap on my AirTouch FF mask tight to avoid leaks. 

My ENT doctor refuses to do any invasive surgery since he says I'm being well treated for apnea. He did DISE procedure and said my tongue base was the major blockage. But I also have recessed bottom jaw which is why I wear an appliance to move it forward.

I want to get my neck straightened and my airway opened so when I tuck my chin at night it won't cause these issues. 

What type of surgeon can fix neck alignment and airway issues like this?
ResMed AirCurve 10 vAuto
Pressure EPAP min 4.4, IPAP 8.4, IPAP Max 18, PS 4.

Post Reply Post Reply



Donate to Apnea Board  
#2
RE: What type of surgeon can fix neck airway, so don't need cervical collar?
That would be an ENT but there would be no gualantees.

Fred
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Post Reply Post Reply
#3
RE: What type of surgeon can fix neck airway, so don't need cervical collar?
The ENT deals with internal structures of the nose mouth and throat. Orthopedics can correct deformities and malformations of the cervical spine. I think the surgery that might benefit you most is actually done by cosmetic surgeons that perform liposuction of the fat around the neck, and can do skin and muscle contouring. That would be a tough sell to insurance. Your ENT is really in the best position to consult you on this, and he is advising against invasive surgery. Good for him! He doesn't make his living by not doing procedures, you just don't need it, or he lacks confidence that the outcome will have sufficient benefits to justify the adverse effects. You can pursue a second opinion, and you're welcome not to listen to mine; I think you're better off listening to your doctor on this one. You have accomplished a lot in your therapy, and it might be as good as it gets.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files

How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Post Reply Post Reply
#4
RE: What type of surgeon can fix neck airway, so don't need cervical collar?
(01-18-2019, 08:27 PM)MyronH Wrote: ...

I want to get my neck straightened and my airway opened so when I tuck my chin at night it won't cause these issues. 

What type of surgeon can fix neck alignment and airway issues like this?

I hesitate to offer my comment because I am nothing like a surgeon of any kind, and not even a health care provider of any description.  But I think you are barking up a tree that won't change things for you at all.  Tucking your chin is ALWAYS going to present a problem for you, and it may actually get demonstrably, horribly, worse after a human gets finished taking your money and tinkering with all that delicate tissue around your cervical spine.  Let's just consider the scar tissue, perhaps displacement of tissues, chronic inflammation, new pains that you currently don't have to deal with.....need I go on?

I would think, if you're hell-bent on doing this to avoid having to wear a cervical collar (and I do get that a collar can have a really serious impact on the quality of your sleep), that a thoracic surgeon might offer some relief, but an orthopedic surgeon is your best bet.  But if you have any bit of the scientist/engineer in you, do your homework.   Run a matrix with some serious and hard truths about what you stand to gain and what you may lose.
Serial Tapist
Post Reply Post Reply



Donate to Apnea Board  
#5
RE: What type of surgeon can fix neck airway, so don't need cervical collar?
Judging by the amount of posts you make and their content, you are searching for something with an impact. I dont think theres any type of surgery that would immobilise your neck movement to eliminate the chin tucking.

Things to consider instead, if you havent done them before:

- remove tonsils
- inspire2 pacemaker
- turbinectomy
- mandibular advancement(to stop using narval)

Don't do any of the surgeries together, it would be too much of a shock to your body.
Post Reply Post Reply
#6
RE: What type of surgeon can fix neck airway, so don't need cervical collar?
Quote:I no longer want to use a cervical collar to keep my neck straight at night. It is too restricting with all the other gear. .... And a chin strap to help keep mouth from opening. Although I still wake up with a super dry mouth some nights. 

If I don't wear the collar, I get major obstructions, dozens of 20-45sec long within a few minutes. Also any minor leaks also can cause these issues. I have to strap on my AirTouch FF mask tight to avoid leaks. 

My ENT doctor refuses to do any invasive surgery since he says I'm being well treated for apnea. He did DISE procedure and said my tongue base was the major blockage. But I also have recessed bottom jaw which is why I wear an appliance to move it forward.

Clearly, what works for one of us is "anecdotal", no indication it will work for another: a wag said that when one has a hammer he tends to see too many problems as nails to be driven. Nevertheless, here I go: I suggest you try staying with the collar (chin straps pulled my jaw back some), ensuring that you sleep only far onto your side (I start getting into trouble if I get inside of about 30 degrees to either side of supine) and try the P10 pillows mask with a mouth seal (consider using Silipos Gel-E-roll). They have a website. I could send you a piece if you PM me.)

Images below are from my 4th sleep session in September 2015 when I was started on 7 cm CPAP and liked to (as I would like to now) sleep on my back; I claim a dubious personal record OA of 155 seconds as can be seen below. But preferring to find a way to sleep above the grass I, like most of us, find and found ways to get better sleep--not that you haven't tried and struggled. (Now my AHI is 0.5 (1 year), 0.3 (6 months), 0.1 (currently 3 and 1 months)--weeks of 0.0 and nights of 0.3 [or even higher] do happen). 

Wearing the F10 FFM I jealously read the praises of the P10, "knowing" it was not for me, a mouth breather that had a dry skinned lizard that climbed into my mouth most nights. Continually awakened by leaks, desperate after doing all the tricks--from tongue-to-teeth suction practice to strap tensioning optimization and chin straps--I decided I should get a P10 and did so, seeing that it had less of a skin contact perimeter to seal. Yeah, I would have to and did tape my mouth and, in effect still do, but with a better mineral-gel backed elastic band (by Silipos): AHI mostly 2.0 to 4.0 then and sleep was vastly improved. 


A board member warned me about asphyxiation risk, so I put the valve-elbow from an F10 near my end of the hose. Though I was seeing those lowered AHI's there were still lots of FR spikes from snores. I saw clusters of OA's the forum taught me were positional. So I got (and do use) a data logging accelerometer with its data graphed in parallel and synchronized with SH and oximeter data graphs.  WOW the position and movement info was compellingly against anything like supine sleep. Not liking that finding, but still liking it above ground, I tried wearing a hard packed fanny pack backwards to keep me off my back. Didn't work. Found an old fashioned mountain or timber surveyor's canvas vest with a huge pocket for rolled plans; filled it tight with two nested cardboard boxes (5" deep x about 10 x 16). Supine sleep problem solved and the numbers and sleep are now as above. 


But I'm working on the "unscored sleep" disturbances now. Those don't get much attention, but there is significant recognition in medical journals where they set the apnea-event scoring rules. I'm still, having too many Snores and Flow Limitations (generating motion, TV  and Pulse spikes). I have my first appointment with a pulmonologist coming up to deal with some pretty bizarre flow rate irregularity curves, including some palatal prolapse once in a while. Experience with other sleep doctors: not good. Fortunately this knew-nothing-then did get a top machine to start with, thanks to my PCP, and I found the two large sleep forums and have learned how to self titrate and much more, with much more to learn.

But 0.0 still covers up a lot of snores and flow restrictions, though scoreable apneas are very few. I see lots of movements coinciding with snores and know that sleep could be much better, no matter how much improved. So many years of OSA leaves me not knowing what truly good sleep is. I count myself fortunate that most all my SA problem is from OA and can be minimized with proper positioning and APAP.

Hope you find something to get required sleep without surgery--which sometimes is necessary and, yes, successful. It may be that it will be recommended to me because of persistent flow limitations and snoring, though not scoreable.

[attachment=9884] [attachment=9882]
Post Reply Post Reply
#7
RE: What type of surgeon can fix neck airway, so don't need cervical collar?
The only thing that would keep your neck straight at night would be cervical fusion. And I do not see any ortho surgeon who would do it. Or one that has good ethics.

I had Anterior Cervical Discectomy and Fusion on C5-C6 a few years ago. I can still bend my head fairly far. The pain and recovery from it was intense. My OI did not change that much but the meds (pain and anesthesia) caused an increase in CI for quite some time.

My opinion? If it were me with the chin-to-the-chest issue?

- forget everything you have done before. Start over.
- change your pillow. Either to a different material (husks vs polyfill vs memory foam vs foam vs ?) or just a new one of the same material.
- stop using the dental thing. It could be the pull from it causes you to curl into the pull in your sleep. If the curl came before the device, still try it without it.
- same with having to super strap down your mask. If you have to do it that tight, it's not the right mask for you. If you use a FFM, it is okay to open your mouth while you sleep. That's what it is for. One of the members has a link in her sig section about the "tongue" technique. http://www.apneaboard.com/forums/User-DariaVader
- and lastly, ditch the collar. I am not a fan of the practice of using one. One of the reasons is that it is a band-aid, not a cure. If the idea is to get you from putting your chin toward your chest, then you aren't training yourself not to do it. You're letting the collar prevent it. This is my opinion. (i've also had to wear a lot of neck braces and the idea of folks willingly sleeping in one makes me shiver)

Don't try everything at once. Start with something and actively try to fix the root problem. And surgery is not going to be one of them.
PaulaO

Take a deep breath and count to zen.




Post Reply Post Reply



Donate to Apnea Board  
#8
RE: What type of surgeon can fix neck airway, so don't need cervical collar?
FWIW It sounds like Paula02 has some great advice backed by a bit of experience. I agree with others on surgery being a no-go.

One thing, it's most likely to be labeled elective surgery, and that probably means you pay cash for it. Secondly, you'll be hard pressed to find a doctor that would do it, whatever that surgery would be, whether that's spinal fusion or something else. IMO of course.

Now about the collar: I thought I would need one as well, but finances delayed the purchase of one. In a substitution for it, I taught myself not to chin tuck as much as was my normal and natural amount, at least it appears to have worked out that way for me. I really want to be able to explain what I did, but it's just that, I consciously stopped doing it.

lots-o-coffee
Dave Sparky DukeNukem

I'm not a doctor in real or fictional life. My posts include opinions based upon user experience and researched info regarding CPAP therapy and should not be considered medically professional directions or advice.


Wiki Info for Beginners
OSCAR Chart Organization
Mask Primer
Post Reply Post Reply


Possibly Related Threads...
Thread Author Replies Views Last Post
  [CPAP] In OSCAR....What is the difference OBSTRUCTIVE AIRWAY " OA" vs HYPOPNEA "H" robertpsimpson 16 344 12-03-2019, 08:13 PM
Last Post: Dogjudge
  Weight loss in obese patients increases upper airway volume JoeyWallaby 2 148 12-01-2019, 10:02 PM
Last Post: 70sSanO
  Time to change mask type? Greg Schultz 5 174 11-27-2019, 07:16 PM
Last Post: booksfan
  Clear airway events after waking and going back to sleep Mpadgett714 28 670 11-05-2019, 05:46 PM
Last Post: alexp
  [Treatment] Positional Apnea and Soft Cervical Collar becker44a 2 244 11-02-2019, 03:59 AM
Last Post: 2SleepBetta
  Cervical Collar: My teeth HURT dneal12 18 493 10-29-2019, 07:42 AM
Last Post: DaveL
  Problems with cervical collar Bassline 17 768 10-19-2019, 05:42 PM
Last Post: DaveL


New Posts   Today's Posts






About Apnea Board

Apnea Board is an educational web site designed to empower Sleep Apnea patients.