- Associated Press - Friday, March 6, 2015

KOKOMO, Ind. (AP) - Lillian Newman had long suffered from the effects of severe sleep apnea.

The regular afternoon naps to compensate for sleepless nights, countless pots of coffee to keep her awake while running the Walnut Street Artisan Shop and failed procedures and technology to correct the apnea left her fatigued, frustrated and hopeless.

After a series of life-altering events in December, which included crashing her son’s car, falling down the stairs and almost setting herself on fire in the kitchen, she knew something outside the box had to be done.

“My sheer fatigue cost me much more than (that) in my relationships. I was irritable because I was literally starving for sleep,” she told the Kokomo Tribune (http://bit.ly/1ETtyV2 ).

According to the American Academy of Dental Sleep Medicine, more than 18 million Americans have sleep apnea, and many are not receiving treatment. Obstructive sleep apnea occurs when tissue in the back of the throat collapses and blocks the airway, reducing the amount of oxygen delivered to all of the organs, including the heart and brain. People with sleep apnea may snore loudly and stop breathing for short periods of time.

Newman’s case was more severe, and required a more extreme surgery as a result. After trying more conventional ways to cure her severe apnea from using CPAP and APAP machines — which use pressurized air to spring open collapsed areas of the airway — to undergoing soft tissue surgeries, it was clear other avenues needed to be explored.

More than two weeks after undergoing a procedure that essentially moved the middle part of her face while cutting apart and re-positioning her jawbone to widen the airway in the process, Newman is resting easy.

“Words cannot express how rested I feel waking up in the morning,” she said. “My own inner thoughts are, ‘Is this what it is like to really get a good night’s sleep?’ I didn’t know what that was. I wake up in the morning rested so well that the long daytime naps are no longer necessary.”

Newman arrived at her new state of restfulness after consulting with longtime specialist Dr. Tod Huntley out of Carmel, who referred her to Dr. David Montes, who specializes in oral and maxillofacial surgery. Montes performed a maxillomandibular advancement surgery in mid-February, breaking her jaw and extending it with implants.

“My sleep endoscopy revealed multiple obstructions in my airway, including a significant collapse,” she said. “It was bad. I was high-risk supine. I could (have) died.”

Obstructive sleep apnea may be a problem for many, Montes said, but few have gone to the lengths Newman has to fix it.

Having such an extreme case of sleep apnea made undergoing maxillomandibular advancement surgery the final option for Newman, outside of a tracheotomy.

“Maxillomandibular advancement was a last-ditch effort in her case,” Montes said. “Most patients never get to that point. It’s for people that are really bad off, and the surgery is pretty difficult, going 4-6 hours, with 6-8 weeks of recovery.”

According to the Sleep Apnea Surgery Center of Palo Alto, California, which provides comprehensive sleep apnea surgical therapy for patients who have failed or declined medical therapies such as nasal CPAP, the surgery has become the most effective treatment for sleep-deprived patients who have tried everything else.

By moving the upper jaw (maxilla) and lower jaw (mandible) forward during the surgery, the entire airway can be enlarged.

It is performed on patients with moderate to severe obstructive sleep apnea when other procedures have failed. It also is performed in patients with significant jaw deformity that contributes to obstructive sleep apnea.

Montes said the surgery has become a viable option since TransOral Robotic Surgery was approved by the U.S. Food and Drug Administration in 2009.

In Newman’s case, her upper and lower jaws were extended 13 mm with implants. A nerve was stretched in the procedure, causing some temporary paralysis with the lower lip, as well as significant swelling.

Montes said the middle of Newman’s face, below the eye socket, was separated and moved forward. That portion of the face and jaw are now held together by six plates and 24 screws following the four-hour procedure.

The surgery is typically risky for patients who need it most, Montes said, whether they are too old, have suffered health problems or are overweight.

Due to the stretching of a nerve connected to the lip and cheek during the surgery, the procedure can cause temporary — and sometimes permanent — numbness or paralysis.

Newman said there has been some numbness in her face, but overall she is seeing more benefits to the surgery than drawbacks.

Montes said Newman’s quality of life from a broad perspective was taken into account when recommending the surgery.

“We really try to inform patients of the good, the bad and the ugly of a surgery like this,” Montes said. “In Lillian’s case, the benefits of being well-rested and being healed outweighed the possible side effects of having a numb chin.”

More than two weeks after the surgery, Newman already notices the impact of being able to sleep through the night and face the day well-rested.

Some days are better than others after the procedure, with some discomfort still occurring when she speaks. She has been limited to drinking liquid foods through a syringe device, with a steady diet of smoothies and pureed vegetable soups.

Her “father’s chin” has been moved forward, leaving her with a new look she describes as “pleasant.” Newman expects her recovery to last another couple of weeks before she can get back to running the artisan shop full time.

Newman said she hopes her surgery and story will be an inspiration to others who have sought solutions to their sleep apnea unsuccessfully.

“More than a few of the population have it, and it’s dangerous,” she said.

___

Information from: Kokomo Tribune, http://www.ktonline.com

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