Maxillomandibular Advancement Surgery Cured my Obstructive Sleep Apnea and Fixed my Weak Jaw/Chin - New York, NY
After years of poor sleep, lack of concentration...
OSA means that, during the night, my lower jaw would relax and fall back into my throat, blocking my airway and causing me to stop breathing. After a period of time, I would wake up gasping for air, as if someone had been choking me and had finally released their grip. This would happen several times per night. Needless to say, I spent many years without a good night's sleep. This lack of sleep caused all sorts of problems such as sleeping during conversations, while driving, etc. It also caused depression. I learned that eventually, it could cause contribute to heart failure. I didn’t realize that I was dealing with such a serious issue. I began to read about the causes of sleep apnea and wondered what was causing mine. I wasn't overweight, didn't drink or smoke, and was in otherwise good health. So the culprit had to be my receding chin and jaw.
I did some research and learned that I would need to consult with an oral & maxillofacial surgeon to find out more about my options. I searched in New York City (where I live) and found Dr. Majid Jamali, who was fantastic (I wrote in more detail about him in his review).
I met with him, he took photos and 360 degree x-rays, he evaluated my sleep study results and determined that I would benefit from a lower Bilateral Sagittal Splint Osteotomy (BSSO) as well as sliding genioplasty. This meant that my lower law and chin would be cut, moved forward, and then screwed back in place. This was no small operation, but I was ready to have my life back.
We moved forward fairly quickly. Once the procedure was approved by my insurance (that took a bit of effort), we scheduled the surgery for the following month.
The day before the operation, Dr. Jamali attached the surgical braces, which were metal bars on my upper and lower teeth, just below my gums, so they were actually barely visible. I wore these for about 3 months.
The following day, I went in to New York Eye and Ear (an excellent hospital, by the way), and had the surgery. I am told it took a total of about 5-6 hours (Dr. Jamali also removed an impacted wisdom tooth). When I woke up, I didn't really feel much pain and I was swollen but not nearly as much as I would have expected. The hospital staff was great, facilities were modern and clean. I stayed in the hospital overnight.
I had scheduled my vacation to coincide with my recovery so I was able to relax and recover for about three weeks, which was just the right amount of time.
The pain was surprisingly mild during the first couple of days immediately after surgery. I started to really feel the pain about the third or fourth day. It was never unbearable though. At its worst, it was just very uncomfortable. I was alternating between Tylenol 3 and 800mg of ibuprofen. The pain started to taper off during the second week. By about the third week, I was taking 400 mg of ibuprofen usually in the morning when I would wake up (I seemed to be most sore at the time), and then another 400 right before bed.
My diet consisted of liquids for about a month and a half - two months. I actually ate everything that I had been eating before the surgery, except in smoothie form. It was kind of fun! I would have my egg and whole wheat toast sandwich smoothie or protein powder smoothie in the morning. Then for lunch, I might have a tuna and pasta smoothie. And for dinner, it could be a steak, quinoa, and raw spinach smoothie! I didn't snack as much during this period, so I lost a little weight (maybe 5-10 lbs). I couldn’t open my mouth for the first couple of weeks, so I had to use a huge syringe to drink my smoothie. That was a bit of a pain. Not long after that, I would just drink it out of a thermos or put it in a bowl and eat it like soup. It took about two months before I was able to have soft foods. By about four months, I was back to my normal diet.
Since I couldn’t open my mouth (and had stitches on the inside of it) I couldn't brush my teeth, so had to gently swish with a special medicated mouth rinse for the first couple of weeks. I also wore rubber bands on my braces, which I had to replace twice daily. Eventually, after about two weeks or so, I was able to gently brush and floss (though I couldn't open my mouth much).
After about two months, the doctor told me to start trying to open my mouth. By this point, my jaw had stiffened a bit from lack of use so I had to literally pry it open and practice opening it wide several times a day. It took a couple of months of this to get it back to normal. Now, 6 months later, there's no pain, and there is only a little stiffness when I try to stretch my jaw muscles by opening my mouth as far as it can go (which is much farther than you would normally ever have to open it).
As for numbness - at first, much of the chin, nose, and cheeks were numb. Feeling began to return after a couple of weeks. Now 6 months later, I have about 85 - 90% of the feeling back. There’s still some numbness but I barely notice it. It can take several months and sometimes all of the feeling doesn’t come back, but that's one of the risks you take.
There have been no unexpected complications during my recovery. I had a couple of nosebleeds at one point early on and learned that it was normal. Other than that, it was relatively easy.
So the whole experience was well worth the trouble. It has been like night and day. I am sleeping so much better now. My disposition has improved tremendously, I have more energy, and I feel rested. And I am happy with the way my jaw and chin look. What more could I want?
If you suspect that you have sleep apnea, have a sleep study done. If it turns out that you do have it, your surgeon will need the results of that sleep study in order for your insurance company to pay for the surgery.
Make sure you find a reputable oral and maxillofacial surgeon who is experienced and who understands the needs of someone who suffers from sleep apnea. Do your research. Read reviews. Get a referral from another doctor you trust. Dr. Jamali was a Godsend for me, so I hope that you may find someone like him and have as good an experience as I have had.
Here are some of my reflections about Dr. Jamali from working with him over the last several months: Professional and cordial - Dr. Jamali is very serious about his work. But, he’s also very friendly and approachable and makes you feel at ease from the first conversation. He listens very attentively to whatever you have to say and answers every question thoughtfully, no matter how silly you may think your question is. You never feel like you are being talked down to or rushed. He treats you like a partner in the process. Attentive to detail, understands facial harmony and aesthetics – During the initial consultation, after sitting down and speaking with me about my sleep apnea, Dr. Jamali carefully examined my face, took photos, and took 360 degree and standard x-rays. Then he spent the next few days carefully studying the images, alongside the results of my sleep study. He concluded that I would benefit most from a Lefort 1 osteotomy on my maxilla, and a bilateral sagittal split osteotomy and sliding genioplasty on my mandibula. In our follow-up appointment a week later, he sat down with me and showed me carefully rendered technical drawings that he had made on tracing paper from my x-rays. By placing his drawings on top of my actual x-rays, Dr. Jamali gave me a very detailed picture of exactly how my jaw and chin would change in relation to the rest of the skull and the precise measurements and degrees/angles of those changes – something I wouldn’t have gotten from computer imaging alone. Even though the procedure was done for medical reasons, Dr. Jamali still made sure that the results were aesthetically balanced. I’m thrilled to say that I no longer suffer from sleep apnea and have a vastly improved jaw and chin as well. His training, knowledge, attention to detail, careful planning, and excellent eye for aesthetics made this possible. An advocate for his patients – My insurance provider did not initially approve the procedure. So Dr. Jamali went through the entire appeal process, submitting more than what was required, and finally, speaking at length with one of their doctors. As a result of Dr. Jamali’s determined efforts and genuine concern for my welfare, the procedure was ultimately approved. Gentle – Dr. Jamali placed surgical braces on my teeth the day before the surgery. Since this was to be done under local anesthetic, he had to inject me several times deep into my gums to numb them. It wasn’t fun, but Dr. Jamali was as gentle as could be, asking me how I felt every step of the way and apologizing if I ever showed any signs of discomfort. Dr. Jamali was also extraordinarily gentle during the actual surgery. I know that because the swelling in my face is nowhere near as bad as it was for others who had had similar procedures done and whose photos I had seen on the Internet. In fact, after only 1 week, I would say about 80% of the swelling that I had on the day following surgery is gone, so much so that you wouldn’t be able to tell by looking at me that I had undergone such a major procedure. This is because Dr. Jamali was very careful and gentle during the surgery. Thorough – Prior to the surgery, Dr. Jamali spoke to me personally, in detail, about all of the possible complications related to this procedure, such as: swelling, facial numbness, changes in appearance, risk of infection, adverse reaction to screws and plates, etc. He could have just sent me home with generic, printed, post-op instructions, but he wanted to be sure that I understood exactly what I was about to go through. Because of this, I felt surprisingly at ease going into surgery and felt quite prepared for the recovery as well. And to his credit, there have been no surprises so far in the recovery process – he covered everything. Accessible – Just prior to surgery, Dr. Jamali gave me his personal cell number so that I could text him with questions or concerns any time, day or night, during the recovery process. Whenever I had any questions about my symptoms or needed more medication, he was always quick to respond. Caring – Perhaps the most remarkable thing about Dr. Jamali was this: While I was recovering overnight in the hospital, he stayed in the room next door to mine so that he could monitor my recovery and make sure that I was being cared for properly. What other doctor would do that? Excellent staff – While this isn’t a reflection on Dr. Jamali per se, I feel it is important to note his excellent staff because you will be working with them just as much as you will be with Dr. Jamali himself. They are all extraordinarily helpful, very organized, and super-friendly. Sometimes I would call or email the office several times a day with questions but they would always be courteous and prompt with their replies. They always made sure that all of my paperwork was in order and submitted in a timely fashion, especially to the insurance company and hospital.