After 30 Years of Snoring, Patient Finds Relief with Surgery

The snoring started when Chuck W. was just 17 years old. “No one really knew what it was or why it was happening – everyone just told me I snored, and badly,” says Chuck. For three decades, his condition remained undiagnosed and he just lived with the snoring and the daytime sleepiness.

When he reached his mid-forties, Chuck decided enough was enough. “I was tired all the time and completely fed up with the snoring so I pursued a sleep study,” he says. The study confirmed that he had severe obstructive sleep apnea due in part to his very small airway that was easily blocked when the soft tissues in his mouth relaxed during sleep.

Multiple Contributing Factors

In addition to his unusually small airway, Chuck was also diagnosed with nasal polyps, a larger than average uvula and a deviated septum – a condition in which the cartilage that separates the nose into two chambers, is off-center. This can make one nasal passage smaller than the other and cause difficulty breathing.

Together, all of these structural anomalies created the perfect storm for Chuck’s snoring and severe sleep apnea.

Finding the Right Treatment

The standard initial treatment for sleep apnea is CPAP or continuous positive airway pressure. This therapy involves wearing a mask at night which forces the airway open with pressurized air. “I tried CPAP for a while but it was uncomfortable and didn’t work very well for me so I went off it,” says Chuck. He would later be told that because his airway was so small, CPAP was like trying to force air through a straw.

After CPAP failed to help his symptoms, Chuck’s doctor recommended surgery to remove his uvula - the little fleshy ball that hangs in the back of your throat. “My uvula would swell up to the size of my tongue,” recalls Chuck. “It almost felt like I was swallowing it.” Doctors hoped the procedure – called an uvuloplasty – would open up the airway enough to reduce Chuck’s apnea symptoms. During the same surgical session, they also removed some of Chuck’s nasal polyps and repaired his deviated septum.

“The recovery was pretty painful but after about a week or so I felt fairly good and was able to resume eating a soft diet.” Ultimately, however, the procedures resulted in some improvement but not enough so Chuck went back to CPAP therapy.

Final Option: Innovative Bone Surgery

Still experiencing symptoms and not satisfied with the CPAP therapy, Chuck turned to Thomaz Fleury, MD, otolaryngologist and sleep surgery specialist at University Hospitals. “Dr. Fleury was the first to mention that my facial bone structure might be at the root of my problem and told me about a bone surgery called maxillomandibular advancement or MMA,” says Chuck. “He said that he had performed the procedure on several people with severe sleep apnea and that it had been very effective in relieving their symptoms. I was sold on it almost immediately.”

What is MMA Surgery?

Maxillomandibular advancement surgery (MMA) is a surgical procedure to treat obstructive sleep apnea (OSA). Also known as double-jaw surgery or bimaxillary advancement surgery, MMA repositions the bones of the upper and lower jaw to help keep the airway open during sleep in patients with moderate to severe obstructive sleep apnea.

MMA is a major surgery that is done in the hospital under general anesthesia and typically requires one or two days of recovery in the hospital. The long-term success rates of MMA for treating sleep apnea are excellent with most patients experiencing improved sleep, enhanced quality of life and reduced daytime sleepiness.

Preparing for the Surgery

“Before proceeding with surgery, Dr. Fleury wanted to make sure I had a good bite so the first step was to be fitted with regular braces,” says Chuck. “My teeth were always very straight on top but the bottom teeth were crowded. I also had a narrow upper palate so a lingual arch appliance was also installed to widen the roof of my mouth.”

“Eating was difficult after the braces were installed and I lost 12 pounds in the first month,” says Chuck.

“I reminded myself that after the surgery I would only be able to have liquids for up to a month so I prepared by changing the way I ate – a few weeks before the surgery I was only having liquids for lunch and by the time I had the procedure, I had lost a total of 20 pounds, which was nice.”

Day of Surgery

Chuck had his MMA surgery on December 14, 2023 and spent three days in the hospital recovering. “Dr. Fleury told me that my post-operative pain level would be about a four on a scale of 1-10. But he was wrong – the pain was very manageable, more like a two,” says Chuck. “My discomfort was well controlled with IV medications while I was in the hospital. Once I was discharged, I took oxycodone for four days but after that, children’s liquid Tylenol was enough. Three days later, I didn’t even need that.”

Recovering after the Procedure

Once discharged from the hospital, Chuck continued to recover and adjust to his new bite at home. After the rubber bands were removed, he was able to transition to soft foods, and was soon able to eat a regular diet.

Chuck lost an additional 20 pounds after surgery and is down to a healthy 186 pounds. Best of all, a follow up sleep study revealed that his sleep apnea had improved significantly. His apnea-hypopnea index (AHI), which measures the average number of apnea episodes per hour of sleep, went from 76 prior to surgery to 6 after surgery – essentially going from severe to mild/none.

“The surgery was the best thing I’ve ever done,” says Chuck. “I’m eating better and exercising more and my girlfriend says I don’t snore at all now, even during allergy season. I highly recommend this surgery and am grateful to Dr. Fleury for presenting it to me as an option.”