Heads-up people!! This video is just for information and isn’t medical or dental advice-I’m not a doctor, dentist or licensed healthcare provider of any kind. Always check with a qualified professional for your health questions. Use this info at your own risk-it’s not meant to diagnose, treat, or recommend specific providers, products or procedures.
The final moments of the video is a cathartic experience as an MMA patient listening to a surgeon imagine the experience. You cannot comprehend the mental processing of what happens to you and how very close to beyond human endurance it really is.
I think another point worth mentioning with conventional CPAP is that it PLACES PRESSURE AGAINST YOUR FACE…this pressure is in essence causing retrusive skeletal forces. Over time, making nighttime breathing WORSE! This is something that a dentist or orthodontist might pick up on quicker than an ENT doctor. We work with skeletal/orthodontic forces all of the time, and realize the consequences of such forces.
Love your work Ron. I often hear you talk about straight neck posture and headaches. I wanted to clarify to everyone that a straight neck is not good (e.g.. military neck), but the neck requires a gentle lordotic curve. A straight neck will cause pain. Also, the position of the shoulders have a large influence on the position of the head and neck, vice versa. Shoulders that are tipped forward, rounded, or protracted will inevitably bring your head and neck along for the ride. You can't have good head/neck posture without good shoulder posture. They're connected.
For intraoral volume, personally I actually prefer what Dr. Bell has shown with the 3D MMA type movements (expand and advance). For nasomaxillary expansion I think I prefer the FME (perfect example would be someone with a severely narrow maxilla, 18-19 mm aperture, etc. I just think that may be more than just a problem with their mouth, palate, etc.). One of the advantages I can imagine with what Dr. Bell has shown with the segmental (and I only mention him because of what he's shown, and the degree of expansion is probably greater than I've seen elsewhere, especially expanding the mandible), but one of the advantages I see is that the segmental is more of a differential expansion, meaning you can expand the 2nd molars more than the 1st molars. I've seen sometimes with MARPE where even if it's parallel, it can max out near the anterior and 1st molars, but then if you look further back, they can still be left tilted, thus suggesting a differential expansion could net a bit more expansion in the back. I also think that a segmental has the possibility of being more symmetric, precise, predictable, etc. I would love to see a study with 3D MMA and OSA and see how that does, vs Zaghi's classic study with the 38.5% cure rate and traditional MMA.
The Bell 5 and 6 piece mandibular MMA surgeries are certainly raising the standard for what's possible with predictable, effective airway treatment. Thanks as always, Shook.
I had an advancement of 15mm at the pogonion. Aesthetically, things are pretty lined up. Since the dust has settled after recovery, I feel I could definitely still use more forward tongue space during the day and for residual SDB during the night. Looking back, I would opt for the larger advancement. The moderate aethetic outcome sounds great until you realise you are not out of the woods sleep wise. I could relate to your jaw/tongue anatomy, am consulting to see if further advancement is a feasible option.
I think it would be help to understand your methylation status before going through jaw surgery and balancing that first if needed to optimize healing at the molecular level.
I enjoyed this immensely and found it very informative and would love an evaluation if I were in the area. I am a post-MMA patient with residual sleep apnea. I have long suspected a large tongue to be a factor. Never had DISE prior to MMA but request it. I think lingual tonsil ablation may be in my future. Please give more credence to ENS risks. The symptoms are real. I am happy to know you only do minimally invasive turbinate down fractures. Not all surgeons do. But ENS is real and devastating risk.
Well, if C1 & C2 is always compensating for jaw instability, it gets tight, causes subluxation. No matter how many times you get it adjusted or massaged, it always goes back to the holding pattern. I wonder how many of us with screwed up jaws have hypermobility? Not EDS, just super lax. I'm in my 50's and can overextend touch my toes, my arms totally rotate outward, my thumbs can bend to my lateral forearm.
For me, i always get headache when i need to be staying focus on my work. Because when we are focusing on something, the tongue when naturally sucking up and i have muscular tongue base due to overwork it(i have pretty abnormal and tight tongue connective tissue). My headache is mostly at the temple area because the muscle is used during the tongue suction. So my solution for now is talk less and reduce the tongue movement to prevent the muscle getting bigger. I wonder if any tongue connective tissue grafting to lengthen it will help?
New follower here. I'm definitely enjoying your videos and have watched a few already. You mentioned you have tried multiple therapies for your headaches, but have you tried Rolfing Structural Integration? If not, you should definitely look into it. Thanks for the excellent videos!
One thing I would've asked him about the turbinate outfracture is if the bone fracture has any effect on the nerve endings or vasculature supporting the nerve endings, and why fracturing a bone doesn't lead to any nerve damage (severing/atrophy)
That is a whole other realm of discussion. I had an MMA with turbinate resection. My turbinates were normal. I’ll never understand why the surgeon intraoperatively decided to remove my inferior turbinates but it resulted in terrible symptoms. The volume change or the nose and damage to the mucosa are implicated in the empty nose syndrome. I can attest ENS is a real and debilitating condition.
Trust me. An MMA will alter your occlusion and even if restorative dentistry is not on your radar, you may decide, as I did, that prosthodontics is going to be essential. I am 5 months post op MMA and completely unable to chew and still on a liquid and soft diet. I’m in Invisalign but can’t wait to get crowns to feel like my function can improve.
@@kathyprince1608 sorry to hear that you got clipped by that train. It's not clear to me why turbinectomies are a thing still outside of some sort of complex sinus surgery where the turbinate has blocked the sinus. But, that's outlier type of stuff. I came across these two studies today: onlinelibrary.wiley.com/doi/abs/10.1046/j.1365-2273.2000.00362.x pmc.ncbi.nlm.nih.gov/articles/PMC6616214/ and both clearly state that the turbinectomy in conjunction with septoplasty had no statistical affect on patient outcomes. That's pretty damning imo.
HI! Have you had a discussion with anyone regarding Expansion and/or Jaw surgery for a 64 year old? I have posterior tongue tie with 27" palate with HIGH V shaped palate. Doing Myofunctional Therapy to get tongue strengthened.... One ORTHO opinion is that he won't touch me with orthodontics - afraid my teeth will break and or concerns with bone strength. Do you know of a provider that has successfully worked with someone in my condition? Thanks
ADDITIONAL question is in regards to CPAP therapy for the sleep apnea caused by my tongue tie.....Will CPAP work correctly? Will we be able to tell if it is not working........Thanks
i wish it was clearer which ENT's had his background. I'm guessing his fellowship in sleep medicine combined with Head and Neck Surgery certification gives him the basis for the big 3: MMA, expansion, septoplasty, but then I look at other folks with the same cert & background, and it's just septoplasty's and uppp with ZERO background in MMA & expansion. Very frustrating. I'm glad it's changing, just wish I was born later
Do you mean, you feel like you are too old now to fix your problems? Or have you already had a bunch of suboptimal procedures and now any additional work would just make a bigger mess of things?
@@JawHacks oh no I mean like the UPenn & Stanford sleep fellowships are tiny (like 5-6 people per year tiny) so it's gonna be awhile till there are more ENT's like Hutz
Ron you had a tongue tie release didn't you? Do you think your tongue got bigger after? Mine sure did. Also, is there a video where you explain where you are in orthodontics right now?
Ron: wearing an cheap off the shelf go2 mouthguard and letting my tounge rest through the hole has done me wonders with the issues you describe yourself having half way through
Going back later for cheek implants might not be the best idea actually depending on the situation. Someone correct me if I'm wrong but don't cheek implants with surgery allow you to advance a little more if the restriction when advancing might be throwing off the harmony. Advancing with cheek implants might allow the surgeon to advance the maxilla more without making the person look like a dog. If you choose to go without the implants, a surgeon might be a little more held back on advancing the maxilla more versus with?
Yes, this is why Walline said he couldn’t advance me without making me look like a monkey. He doesn’t do cheek aug. Whereas other surgeons had no problem going over 8mm because they would do high cut or cheek aug.
@JawHacks well overall,still answers questions I send via portal as well. I reccomend him, and mentioned to him to get a youtube presence , as there simply aren't alot of doctors on social media about expansion etc, there is a need for sure.
Heads-up people!! This video is just for information and isn’t medical or dental advice-I’m not a doctor, dentist or licensed healthcare provider of any kind. Always check with a qualified professional for your health questions. Use this info at your own risk-it’s not meant to diagnose, treat, or recommend specific providers, products or procedures.
The GIF at 46:05 is courtesy of Shuikai.
The final moments of the video is a cathartic experience as an MMA patient listening to a surgeon imagine the experience. You cannot comprehend the mental processing of what happens to you and how very close to beyond human endurance it really is.
Wow thanks for sharing that. I assume you have your own experience with jaw surgery?
I think another point worth mentioning with conventional CPAP is that it PLACES PRESSURE AGAINST YOUR FACE…this pressure is in essence causing retrusive skeletal forces. Over time, making nighttime breathing WORSE!
This is something that a dentist or orthodontist might pick up on quicker than an ENT doctor.
We work with skeletal/orthodontic forces all of the time, and realize the consequences of such forces.
Interesting point. Not to mention the retractive pressure of the mask being strapped onto your face.
Hi Ron we would appreciate if you could bring dr coppelson. We need to understand more regarding his MIND technique
Love your work Ron. I often hear you talk about straight neck posture and headaches. I wanted to clarify to everyone that a straight neck is not good (e.g.. military neck), but the neck requires a gentle lordotic curve. A straight neck will cause pain.
Also, the position of the shoulders have a large influence on the position of the head and neck, vice versa. Shoulders that are tipped forward, rounded, or protracted will inevitably bring your head and neck along for the ride. You can't have good head/neck posture without good shoulder posture. They're connected.
I agree with your point about the interconnectedness of shoulder and neck posture.
For intraoral volume, personally I actually prefer what Dr. Bell has shown with the 3D MMA type movements (expand and advance). For nasomaxillary expansion I think I prefer the FME (perfect example would be someone with a severely narrow maxilla, 18-19 mm aperture, etc. I just think that may be more than just a problem with their mouth, palate, etc.).
One of the advantages I can imagine with what Dr. Bell has shown with the segmental (and I only mention him because of what he's shown, and the degree of expansion is probably greater than I've seen elsewhere, especially expanding the mandible), but one of the advantages I see is that the segmental is more of a differential expansion, meaning you can expand the 2nd molars more than the 1st molars. I've seen sometimes with MARPE where even if it's parallel, it can max out near the anterior and 1st molars, but then if you look further back, they can still be left tilted, thus suggesting a differential expansion could net a bit more expansion in the back. I also think that a segmental has the possibility of being more symmetric, precise, predictable, etc.
I would love to see a study with 3D MMA and OSA and see how that does, vs Zaghi's classic study with the 38.5% cure rate and traditional MMA.
The Bell 5 and 6 piece mandibular MMA surgeries are certainly raising the standard for what's possible with predictable, effective airway treatment.
Thanks as always, Shook.
By the way, the GIF at 46:05 is courtesy of Shuikai.
I had an advancement of 15mm at the pogonion. Aesthetically, things are pretty lined up. Since the dust has settled after recovery, I feel I could definitely still use more forward tongue space during the day and for residual SDB during the night. Looking back, I would opt for the larger advancement. The moderate aethetic outcome sounds great until you realise you are not out of the woods sleep wise. I could relate to your jaw/tongue anatomy, am consulting to see if further advancement is a feasible option.
How much was the maxilla advanced ?
I think it would be help to understand your methylation status before going through jaw surgery and balancing that first if needed to optimize healing at the molecular level.
I enjoyed this immensely and found it very informative and would love an evaluation if I were in the area. I am a post-MMA patient with residual sleep apnea. I have long suspected a large tongue to be a factor. Never had DISE prior to MMA but request it. I think lingual tonsil ablation may be in my future.
Please give more credence to ENS risks. The symptoms are real. I am happy to know you only do minimally invasive turbinate down fractures. Not all surgeons do. But ENS is real and devastating risk.
Thanks for sharing Kathy. It sounds like you are quite deep in this space, at an experiential level.
Well, if C1 & C2 is always compensating for jaw instability, it gets tight, causes subluxation. No matter how many times you get it adjusted or massaged, it always goes back to the holding pattern. I wonder how many of us with screwed up jaws have hypermobility? Not EDS, just super lax. I'm in my 50's and can overextend touch my toes, my arms totally rotate outward, my thumbs can bend to my lateral forearm.
For me, i always get headache when i need to be staying focus on my work. Because when we are focusing on something, the tongue when naturally sucking up and i have muscular tongue base due to overwork it(i have pretty abnormal and tight tongue connective tissue). My headache is mostly at the temple area because the muscle is used during the tongue suction. So my solution for now is talk less and reduce the tongue movement to prevent the muscle getting bigger. I wonder if any tongue connective tissue grafting to lengthen it will help?
New follower here. I'm definitely enjoying your videos and have watched a few already. You mentioned you have tried multiple therapies for your headaches, but have you tried Rolfing Structural Integration? If not, you should definitely look into it. Thanks for the excellent videos!
One thing I would've asked him about the turbinate outfracture is if the bone fracture has any effect on the nerve endings or vasculature supporting the nerve endings, and why fracturing a bone doesn't lead to any nerve damage (severing/atrophy)
That is a whole other realm of discussion. I had an MMA with turbinate resection. My turbinates were normal. I’ll never understand why the surgeon intraoperatively decided to remove my inferior turbinates but it resulted in terrible symptoms. The volume change or the nose and damage to the mucosa are implicated in the empty nose syndrome. I can attest ENS is a real and debilitating condition.
Trust me. An MMA will alter your occlusion and even if restorative dentistry is not on your radar, you may decide, as I did, that prosthodontics is going to be essential. I am 5 months post op MMA and completely unable to chew and still on a liquid and soft diet. I’m in Invisalign but can’t wait to get crowns to feel like my function can improve.
@@kathyprince1608 sorry to hear that you got clipped by that train. It's not clear to me why turbinectomies are a thing still outside of some sort of complex sinus surgery where the turbinate has blocked the sinus. But, that's outlier type of stuff.
I came across these two studies today:
onlinelibrary.wiley.com/doi/abs/10.1046/j.1365-2273.2000.00362.x
pmc.ncbi.nlm.nih.gov/articles/PMC6616214/
and both clearly state that the turbinectomy in conjunction with septoplasty had no statistical affect on patient outcomes. That's pretty damning imo.
Good points all around.
This is literally my ENT 😂
Haha, nice
Great interview . Ron your interviews are getting better and better !
The turbinates are very good at adjusting themselves. Don't touch the turbinates!
HI! Have you had a discussion with anyone regarding Expansion and/or Jaw surgery for a 64 year old? I have posterior tongue tie with 27" palate with HIGH V shaped palate. Doing Myofunctional Therapy to get tongue strengthened.... One ORTHO opinion is that he won't touch me with orthodontics - afraid my teeth will break and or concerns with bone strength. Do you know of a provider that has successfully worked with someone in my condition? Thanks
ADDITIONAL question is in regards to CPAP therapy for the sleep apnea caused by my tongue tie.....Will CPAP work correctly? Will we be able to tell if it is not working........Thanks
He talked about attending Dr. Gunson's seminar. Where can we find information on seminars like this to possibly attend?
The course is probably through Spear continuing dental ed, although I'm not certain. You could monitor their site.
i wish it was clearer which ENT's had his background. I'm guessing his fellowship in sleep medicine combined with Head and Neck Surgery certification gives him the basis for the big 3: MMA, expansion, septoplasty, but then I look at other folks with the same cert & background, and it's just septoplasty's and uppp with ZERO background in MMA & expansion. Very frustrating. I'm glad it's changing, just wish I was born later
Do you mean, you feel like you are too old now to fix your problems? Or have you already had a bunch of suboptimal procedures and now any additional work would just make a bigger mess of things?
@@JawHacks oh no I mean like the UPenn & Stanford sleep fellowships are tiny (like 5-6 people per year tiny) so it's gonna be awhile till there are more ENT's like Hutz
Ron you had a tongue tie release didn't you? Do you think your tongue got bigger after? Mine sure did. Also, is there a video where you explain where you are in orthodontics right now?
Ron: wearing an cheap off the shelf go2 mouthguard and letting my tounge rest through the hole has done me wonders with the issues you describe yourself having half way through
Did you ever have any nasal breathing issues?
Thanks for sharing that brother I will check it out.
Going back later for cheek implants might not be the best idea actually depending on the situation. Someone correct me if I'm wrong but don't cheek implants with surgery allow you to advance a little more if the restriction when advancing might be throwing off the harmony. Advancing with cheek implants might allow the surgeon to advance the maxilla more without making the person look like a dog. If you choose to go without the implants, a surgeon might be a little more held back on advancing the maxilla more versus with?
Yes, this is why Walline said he couldn’t advance me without making me look like a monkey. He doesn’t do cheek aug. Whereas other surgeons had no problem going over 8mm because they would do high cut or cheek aug.
Walline said the same exact thing to me.
Ha also had him do my sarpe surgery!
Nice how did that go?
@JawHacks well overall,still answers questions I send via portal as well. I reccomend him, and mentioned to him to get a youtube presence , as there simply aren't alot of doctors on social media about expansion etc, there is a need for sure.
Well, here he is, on TH-cam! Thanks for sharing your experience.