Correcting OSA with Jaw Surgery
Otherwise known as ‘Obstructive Sleep Apnea,’ this sleeping disorder is notorious when it comes to quality rest and peaceful slumber. This potentially serious condition may be most familiar in the form of snoring that’s so loud it may as well “wake up the neighborhood.”
Snoring, which is one of its widely known symptoms, has become so common that it’s talked about now in a harmless manner as a quip or a funny icebreaker. For others, it can go as far as be a threat to their marriage, or cause stress among the people in the household. Unfortunately, if left untreated, did you know that it can actually develop into something life-threatening? In this article, we will go over its usual causes, and how orthognathic surgery is now paving the way for not only quiet nights, but restored functions and normal appearance.
What is it?
OSA is a disorder that involves a significant decrease in airflow in the presence of breathing effort. In layman’s terms, this apnea is experienced when your throat muscles intermittently relax and block your airway while sleeping - hence, the snoring.
What causes it?
There are several factors that can lead to a blockage or collapse of your airway. Some of them are the following:
Lax muscles and other tissues in the mouth and throat
Nasal congestion
Thickened tissues and additional fat stores around the airway
An underlying neurological problem
Congenitally small or malpositioned jaw
Aside from obesity, these may come about from genetic factors.
Expected health risks
Health risks generally develop gradually and can be unattended for years before a patient is recommended for evaluation. Because of the decreased oxygen supply to the brain and consequently, other parts of the body, sleep quality is expected to be poor, making daytime alertness to be difficult and erratic.
At night, the following are usual risks for a person who has OSA:
Snoring, usually loud, habitual, and bothersome to others
Witnessed apneas, which often interrupt the snoring and end with a snort
Gasping and choking sensations that arouse the patient from sleep
Nocturia, where you wake up because of the need to urinate
Insomnia; restless sleep, with patients often experiencing frequent arousals and tossing or turning during the night
During the day, a patient may experience the following:
Nonrestorative sleep (ie, “waking up as tired as when they went to bed”)
Morning headache, dry or sore throat
Excessive daytime sleepiness that usually begins during quiet activities (eg, reading, watching television); as the severity worsens, patients begin to feel sleepy during activities that generally require alertness (eg, school, work, driving)
Daytime fatigue/tiredness
Cognitive deficits; memory and intellectual impairment (short-term memory, concentration)
Decreased vigilance
Morning confusion
Personality and mood changes, including depression and anxiety
Sexual dysfunction, including impotence and decreased libido
Gastroesophageal reflux
Hypertension
Normal Jaws for a Normal Life
Sometimes it’s not a simple fix of changing your lifestyle or improving your posture. Everyday we come across people who have unfortunately learned to accept that if they are born with it, they are stuck with it — which is definitely not the case.
It may be difficult to determine what is considered to be normal for our bodily functions especially if you grew up knowing only that, and over the years learned how to cope with having deformities. As PAPRAS surgeons who’ve had extensive training and practice, our goal is to do what is necessary to ensure you get to live a normal life without any of your functions inhibited. This includes recommending reconstructive surgeries.
Treating OSA away
Depending on the severity and other present and/or underlying conditions, different treatments and approaches can be recommended. The general goal is to make sure your airflow is not obstructed throughout your sleep and as you carry out your daily activities. Usual treatment methods may include: weight loss, nasal decongestants, positional therapy, machines, and reconstructive surgeries.
Orthognathic Surgery
More simply known as jaw surgery, multiple studies have shown that this reconstructive surgical treatment is proven to be very efficacious in eliminating OSA. This is done by enlarging your posterior airway space (an area near the back of your tongue), and tightening the upper airway muscles and tendons.
Likewise, people born with a congenitally small or malpositioned jaw are recommended this surgery. This is undertaken to correct the position and function of the jaws, teeth, and overlying soft tissues relative to each other and the rest of the face.
Orthognathic surgery is similarly undertaken to normalize facial proportions and improve how your teeth fit together. This is often an alternative when years of orthodontic treatments yield unsatisfactory results. Your PAPRAS surgeon will evaluate your facial anatomy and determine the treatment plan to remedy your concerns from the root.
What it fixes
Sleep Apnoea. To provide a more holistic treatment plan, this surgery can be done as a complement to other therapies and interventions. The jaw relationship is surgically altered to increase the capacity of the airway passage and enhancement of respiration.
Malocclusion and Function. Most often, people come in with overcrowded and poorly aligned teeth reporting functional problems with their bite. Some complaints we’ve heard are on protruding ‘buck’ teeth, or on having an open bite with an inability to bite into food which tends to also require effort to close the mouth and lips with consequent mouth breathing and challenges to oral hygiene.
Over-biting, on the other hand, can cause trauma to the gums and bone with consequent loss of teeth and bone volume which leads to the premature ageing of your face.
Some of these functional dentistry on demands can be addressed with orthodontics alone. However, in many cases, joint orthodontic and surgical treatment is mandatory as the problem may appear as purely dental overcrowding, but the underlying diagnosis is a combination of small/large jaws and dental discrepancies.
It is not unusual for many patients who have had orthodontic treatments for these problems without the input of corrective jaw surgery, to return with relapsed orthodontic issues (teeth going skew again). With this level of complexity, we PAPRAS surgeons work with an integral approach, and refer you to the right experts should the need arise.
Facial Injuries. Post-injury and post-traumatic facial deformities can also be addressed with jaw surgery. Often jaws are set in the wrong place with problems on occlusion and the teeth meeting properly which follows issues in biting.
What to expect
For your safety, orthognathic surgery is only done by major surgery through hospital admission. On the day of your consultation, your PAPRAS surgeon may:
Evaluate your general health status and any pre-existing health conditions or risk factors
Take photographs
Discuss your orthognathic surgery options
Recommend a course of treatment
Discuss likely outcomes of surgery and any potential risks
Discuss the type of anesthesia that will be used
It's natural to feel some anxiety, whether it's excitement for your anticipated new look or a bit of preoperative stress. Feel free to discuss these feelings with your surgeon.
References:
DerSarkissian, Carol. “Causes of Obstructive Sleep Apnea.” WebMD, 22 May 2019, https://www.webmd.com/sleep-disorders/sleep-apnea/obstructive-sleep-apnea-causes. Accessed 23 February 2021.
Healthline. “What you need to know about sleep apnea.” Medical News Today, 17 December 2020, https://www.medicalnewstoday.com/articles/178633. Accessed 24 February 2021.
Lights, Verneda, and University of Illinois. “Obstructive Sleep Apnea.” Healthline, 31 March 2017, https://www.healthline.com/health/sleep/obstructive-sleep-apnea. Accessed 24 February 2021.
“Obstructive sleep apnea.” Mayo Clinic, 05 June 2019, https://www.mayoclinic.org/diseases-conditions/obstructive-sleep-apnea/symptoms-causes/syc-20352090. Accessed 23 February 2021.
Sleep Review. “When OSA Threatens Marriage.” 3 November 2009, https://www.sleepreviewmag.com/sleep-diagnostics/in-lab-tests/polysomnography/when-osa-threatens-marriage/. Accessed 23 February 2021.
Wickramasinghe, Himanshu, and Zab Mosenifar. “Obstructive Sleep Apnea (OSA).” Medscape, 15 September 2020, https://emedicine.medscape.com/article/295807-overview. Accessed 23 February 2021.
Mehra, P, and L M Wolford. “Surgical management of obstructive sleep apnea.” Proceedings (Baylor University. Medical Center) vol. 13,4 (2000): 338-42. doi:10.1080/08998280.2000.11927701
American Society of Plastic Surgeons. “Orthognathic Surgery.” https://www.plasticsurgery.org/reconstructive-procedures/orthognathic-surgery. Accessed 25 February 2021.
Bayside Oral Surgery. “Orthognathic (Jaw) Surgery.” https://www.baysideoralsurgery.com.au/index.php?page=Orthognathic%20(Jaw)%20Surgery. Accessed 25 February 2021.