Tag Archives: Dr. Kayvon Haghighi

Maxillomandibular Advancement (MMA) for Sleep Apnea

There are several treatment options available for Obstructive Sleep Apnea (OSA) including weight loss and behavior modification like changing sleep position or decreasing alcohol consumption. Oral devices have been successful and Continuous positive airway pressure (CPAP) breathing devices are common, and can be effective if used properly. However, some patients prefer a remedy that allows freedom from the burden of sleeping tethered to a machine for the rest of their lives.

A surgical procedure known as Maxillomandibular Advancement (MMA) is a viable first line treatment option for specific candidates who meet the criteria for success. Younger age, lower body mass index (BMI), and existing anatomical structure are a few of the patient characteristics that predict greater surgical success. Most patients who choose this treatment option report satisfaction with OSA-related quality of life measures and with the reduction of daytime sleepiness.

MMA surgery actually changes the shape of the patient’s airway. This action reduces the collapsibility of the upper airway space, which improves or resolves the OSA (American journal of orthodontics and dentofacial orthopedics.)

Typical OSA symptoms of snoring and snorting, or the periodic interruptions in breathing which can leave the person gasping for air, are an annoyance to the patient and his or her partner. More importantly, these signs of sleep apnea are also linked to many serious health threats including heart disease, high blood pressure, Type 2 diabetes, weight gain, asthma, acid reflux and car accidents.

One measure used to grade the severity of OSA is the number of breathing cessations that occur per hour of sleep, known as the apnea-hypopnea index (AHI). Another measure is the reduction in blood oxygen levels that result from these stoppages. It is essential for the OSA patient to familiarize himself with success rates and potential pitfalls of various treatment options. He should discuss all treatment alternatives with his trusted healthcare professionals so he is able to make an informed decision on his course of action.

MMA corrects particular craniomaxillofacial abnormalities that are a known cause of the condition. MMA enlarges the skeletal framework of the jaw, which then enlarges the narrowed airway. MMA has been used to treat OSA for about three decades. The surgical procedure, which moves the maxilla and mandible forward by approximately 10 millimeters, has been shown to result in a cure rate of 97% for OSA. Substantial and consistent reductions in the AHI were observed following MMA; adverse events were uncommonly reported. (Surgical Modifications of the Upper Airway for Obstructive Sleep Apnea in Adults: A Systematic Review and Meta-Analysis; www.journalsleep.org)

What results determine whether or not a treatment is deemed successful? The patient’s self-reported resolution of the snoring and other symptoms of obstructive sleep apnea and acknowledgement of improved sleep quality are a major indication that the treatment was successful. Data showing a lower AHI score and restored oxyhemoglobin confirm the clinical results.

When performed by a skilled surgeon, MMA surgery is generally safe and highly effective for treating obstructive sleep apnea and its associated health risks. Corrective jaw surgery can deliver more predictable, permanent results by moving the lower jaw forward to relieve airway obstruction. If you’ve been diagnosed with sleep apnea, or you think you may be suffering from sleep apnea, schedule a consultation so we can discuss the best treatment plan. For more detailed information about MMA surgery visit http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2941427/

picture crop Maxillomandibular Advancement (MMA) for Sleep ApneaKayvon Haghighi, DDS, MD, FACS is licensed to practice both medicine and dentistry in the state of New Jersey. Dr. Haghighi’s unique combination of surgical training and experience in facial reconstruction enables him to analyze your condition from multiple points of view.

 

 

 

 

 

Wake Up to the Perils of Excessive Daytime Sleepiness

bigstock Wake Up 52772422 Wake Up to the Perils of Excessive Daytime SleepinessHey, sleepyhead…wake up! If you suffer from sleep apnea (or another sleep disorder) and seem to be hearing this command frequently from colleagues or loved ones, you may be experiencing excessive daytime sleepiness. Take heart, though, you’re not alone. Nearly a quarter of us routinely feel so drowsy it negatively affects our work life, studies, leisure activities and interpersonal relationships.

More than a third of all adults, and up to half of younger adults, admit to sometimes nodding off during the day. Planned cat naps don’t count. These unintentional episodes of sleep may signal a chronic sleep disorder, such as sleep apnea. In general, getting seven to nine hours of sleep per night is the ideal, but not nearly the norm for almost half of adults. Lack of concentration and impaired memory have been reported by roughly 20 percent of sleep-deprived adults.

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Prevention — The Best Policy for Avoiding Maxillofacial Injuries

seatbelts Prevention — The Best Policy for Avoiding Maxillofacial InjuriesMaxillofacial trauma can be extremely complex and intricate. Different regions of the face control critical functions like seeing, tasting, smelling, speaking and breathing.  Like the old adage advises, prevention of maxillofacial injury is truly the best medicine. Products and practices designed to safeguard the face are readily available, but sometimes people are distracted or forgetful and neglect to implement them. 

Automobile accidents are a major cause of facial injury. While wearing a seat belt in a car has become second nature to most of us, there are still some who find the restraints constricting and uncomfortable. Too often the consequence of not buckling up is facial injury. As the vehicle operator, the driver must set the standard by wearing a seatbelt.  Laws mandate and define the use of approved car seats for children. The child safety seat must be fastened in the back seat of the car according to the manufacturer’s instructions. Verify that each passenger is buckled in before proceeding.

Recreational sports injuries are another frequent cause of injury. Wearing appropriate protective mouth guards, masks, helmets or headgear for activities like mountain biking, skateboarding, rock climbing, skiing, snowboarding and others is an important step toward prevention of harm. Be sure to wear a mouth protector when participating in contact sports. (A follow-up post will discuss recommended protective sports equipment in more detail.)

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What is Sleep Apnea?

sleep apnea What is Sleep Apnea? Who doesn’t look forward to a restful night’s sleep after an active day of working or recreational exercise? Sleep allows our bodies to recharge, gearing up for another 16 hours or more of life, driving, walking, working out, attending meetings or taking care of children. Those with sleep apnea, however, may not experience the deep sleep needed to rejuvenate the body. Sleep apnea (AP-ne-ah) is a common but potentially serious sleep disorder in which shallow breathing or pauses in breathing occur while sleeping.

These involuntary interruptions in breathing can last just a few seconds or extend for a frighteningly long span of minutes. When normal breathing resumes it is sometimes accompanied by a resounding snort or choking sound. The pauses in breathing can happen every few minutes in some cases, preventing deep sleep from occurring. Sleep apnea patients often present with symptoms of excessive and persistent daytime sleepiness.

“Apnea” is a Greek word that means “without breath.” There are three types of sleep apnea, obstructive, central and mixed. Each leads to a hitch in breathing, but for different reasons. Typically, the sleeper isn’t even aware of these lulls. According to sleepapnea.org, without treatment sleep apnea can lead to cardiovascular disorders like high blood pressure, heart disease or stroke; automobile accidents caused by falling asleep at the wheel; memory problems, weight gain, headaches and other maladies.

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Additional Surgical Corrections for Cleft Lip and Cleft Palate

In a previous post, we introduced some procedures required for repair of a cleft lip and/or palate. Those surgeries reconstructed the groove between the nostrils and upper lips; the border between reddish lips and normal skin; the nostril area and the muscles of the mouth and lips. Sometimes, further surgical corrections are required. They may include the following.

Alveolar Bone Grafts

When a child’s cleft affects the dental ridge of the upper jaw, bone grafting is often necessary.  Bone grafting is a procedure involving the transference of bone material from one area of the body to another.  For example, cancellous bone, which is light and porous, can be harvested from the hip area and placed in the area of the cleft near the teeth. The bone tissue will then begin to regenerate and build new bone in the area.

Bone grafting is most successful in patients under 10 years old and is performed on patients as young as 5 or 6 years old as the front incisor teeth are erupting. (Dental x-rays show the development of the permanent teeth.) Although older patients may also benefit from a bone graft, the results are not as good, especially if the patient is a smoker, has a systemic disease such as diabetes or has poor oral hygiene.

Once the bone graft has been placed, one of three options will be implemented to replace missing teeth. Teeth positioned adjacent to the bone graft will be moved into the graft area; a prosthetic replacement called a dental bridge may be used; or dental implants will be inserted. The dental specialists on the cleft palate team will advise which option is best for the patient.

A bone graft to the dental ridge serves several different purposes. It supports teeth that have not yet grown in and those that are next to the cleft. It provides symmetry to the face and supports the lip and nose. It creates a more natural appearance by forming a contiguous upper gum line. The front part of the roof of the mouth becomes stabilized, especially when a bilateral cleft is present. Even when the bone graft is placed after the permanent teeth have erupted, between the ages of 10 and 12 in most cases, it may still be useful for support purposes.

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Cleft and Craniofacial Awareness Month

1979348 677049749025415 81190253 o Cleft and Craniofacial Awareness Month

July is National Cleft & Craniofacial Awareness & Prevention Month (NCCAPM) in the United States.  Ameriface and Cleft Advocate established the campaign to promote public awareness and prevention of cleft and craniofacial conditions.

When a parent of a newborn with cleft lip, cleft palate, or another craniofacial condition has questions about what lays ahead, AmeriFace http://www.ameriface.org has answers. The organization is dedicated to educating and supporting those affected by facial differences. It also seeks to educate the public about the conditions by creating awareness programs such as NCCAPM. Facial differences include those present at birth as mentioned above, or acquired via illness, disease or trauma. Stroke, cancer, accidents, animal bites and burns are some causes of acquired facial differences.

Reviewers of AmeriFace, a non-profit organization, describe their association with the online support group as life- changing. The process of healing craniofacial deformities is long and complex. Emotions run rampant and questions abound as parents seek information about what the future holds. Ameriface provides a place where they can connect and communicate with others who have traveled a similar path and those that are also beginning the journey.

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Detecting a cleft lip or cleft palate

bigstock Midsection of doctor performin ultrasound pregnant belly Detecting a cleft lip or cleft palateCleft lip and/or cleft palate can occur in a developing fetus for several reasons. One cause is genetic; the gene can be passed down from one or both parents. Drugs, viruses and toxins are some other causes of the birth defects. Sometimes the deformity is detected during pregnancy. High-tech ultrasonography allows doctors to view well-defined, two-dimensional images of a developing fetus. These high-resolution sonograms can reveal abnormalities of the face, including cleft lip. Although cleft palate is most often diagnosed after birth, in some cases ultra-precise three-dimensional ultrasonography and prenatal magnetic resonance imaging (MRI) may aid an in utero diagnosis.

By the fourth to sixth week of fetal development, the nose, lip, and part of the hard palate are formed. However, the facial features are not generally detectable with imaging equipment until 16-18 weeks. It is possible to diagnose a baby with cleft lip during a routine fetal check-up at approximately 18 weeks gestation. A second-trimester sonogram can show whether a baby has a normally shaped skull. Doctors look for signs that the skull has fused prematurely or if either side of the head is smaller than expected. Slight differences in facial structures are not always evident with prenatal ultrasonography. Many irregularities cannot be detected until after the baby is born.

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