AboutNewell Mekemson Expertise I am an expert in surgical solutions for obstructive sleep apnea. I can answer any quetsion related to different surgical interventions. In addition to surgeries, I have personal experience and knowledge with CPAP/Bi-PAP and AutoPAP machines. I have struggled with sleep apnea for almost ten years. In the process, I have had to conduct extensive reseach in an attempt to help solve a problem that doctors were stumped by.
I have had cutting-edge surgeries performed at Stanford University Medical Center; many of these procedures are not widely known or performed by other doctors in the US. These surgeries inclue a maxillomandibular advancement, genioglossus advancement, turbinoplasty, partial turbinectomy, uvulectomy, tonsilectomy, nasal valve reconstruction, two septoplasties and multiple radiofrequency treatments on the base of my tongue.
I am currently going through orthodontic treatment to prepare me for a maxillomandibular expansion. I have extensive knowledge in the link between physiology and sleep apnea.
I want to help individuals in understanding their sleep study, figuring out why their cpap may or may not be working for them and discuss possible surgical alternatives to the cpap.
I can also provide answers for the parents of children with OSA in regards to the importance of addressing OSA/snoring early childhood. This promotes normal facial growth and development as well addresses issues with bed wetting and ADHD.
Experience Credits completed at four colleges; extensive research in the area sleep apnea.
Expert: Newell Mekemson Date: 6/26/2008 Subject: Dr. Kasey LI
Question I have been diagnosed with severe sleep apnea. My RDI is 41.
However, my blood oxygen saturation averaged 94% during the evening with a low of 90%. After several months I am certain that I cannot tolerate CPAP. Rather than the more common UPP, I believe that an MMA would be more appropriate for me. I am not overweight. In fact I am thin and in good physical shape. The only risk factor for me having apnea, is that I have a narrow jaw. After several months, I am certain that I cannot tolerate CPAP. I am consieding an MMA. To me this seems preferable to having the excess throat tissue and uvula removed. I saw your answer about surgeons that mentioned Dr. Kasey Li. You mentioned that he was associated with the Stanford University Medical Center.
The only contact information I have come across for Dr. Li is for the Sleep Apnea Surgery Center in East Palo Alto. Is Dr. Li still associated with Stanford? Also, what are the criteris that they will use for detrmining whether I am an appropriate candidate for an MMA? How bad is the post-operative pain? How long is the recovery? Is the success rate for MMA's higher than 70%?
Answer Hello,
Any severity of sleep apnea should be addressed, and in your case it is considered severe. You are not to far from my primary RDI of 37. Despite the respiratory disturbance index, every "victim" responds differently regardless of the number of arousals.
If you feel you have a recessive jaw, you are most likely a good candidate for the MMA. When you go in for a consultation, the doctor will do a fiberoptic scope of your airway, while reclined in a chair. This will give him an idea as to how large your airway is. He will also take some x-rays. He will be able to tell you if you are a good candidate for the MMA.
Your wish to bypass the UP3 is valid. I know that Dr. Li will often recommend the MMA (instead of UP3) if the jaw is recessed. His goal is to enlarge the airway and target the area of obstruction. He can assess what area needs to be addressed and what surgery would be appropriate. It sounds to me like your speculations are probably correct, as were mine.
Dr. Li's website is drkaseyli.com. He does all of his surgery at Stanford, and currently has his own practice. Before opening private practice, he was previously partnered with Dr. Robert Riley and Dr. Nelson Powell, who are also world-renown sleep surgeons. They also do their surgeries at Stanford. Dr. Li's office is in East Palo Alto, just a few miles from Stanford Medical Center.
The post-operative pain is controlled by strong painkillers. The severity of pain is all relative, depending on your pain thresh hold. I would not let that discourage you from a life-saving, and positive, life-altering surgery. The pain is managed with the meds, but with any surgery, you will have discomfort. The recovery is more tedious than painful -- not being able to chew for a few months, the swelling, difficulty speaking for a few weeks, etc.
From what I have read, success rate of MMA is usually listed around 90-95%. Keep in mind, "success" of sleep surgery is reducing the RDI by 50% or more. Many patients will have significant improvement of their RDI, but surgeons can never promise any specific result. This is something you can speak with him more in depth.
Dr. Li may also recommend a genioglossus advancement, which is commonly done in conjunction with MMA. This is a chin advancement that pulls the muscle of the tongue forward, through the chin (tightens it). You can view all of these surgeries on his website. www.sleepnet.com has also been a wonderful resource for me.
