Ralf Nuremberger

Patient report in explicit support of a decision for a bimaxillary advancement with rotation (maxillomandibular advancement - MMA).

For many years I suffered from very poor sleep, caused by breathing stops and heavy snoring. My wife hardly dared to fall asleep next to me herself, as she constantly shook me awake again after breathing stops out of fear for my health. Finally she urged me, quite rightly, to have myself examined in a sleep laboratory. The result of the examinations, which lasted several days, was very clear with an average of 52 episodes per hour - obstructive sleep apnea with central components.

I was prescribed therapy to relieve me of significant sleep disturbances with nightly pressure ventilation(CPAP machine- with nasal mask).

I wore the device very disciplined and regularly always during my sleep phases. I used the CPAP mask for eight years and went to the sleep lab for regular checkups. Putting up with all the adversities of use (poor sleep, pressure on my face, noise pollution, sweating in the summer, flatulence, etc.).

I never really got used to the whole procedure, the device and the mask in a way that was acceptable to me.

In addition, frequent lack of sleep, daytime fatigue, dejection, listlessness and high blood pressure were accompanying symptoms that I no longer wanted to put up with. At that time, I had a stressful and responsible job with above-average working hours and high stress levels.

The real risk of this disease, however, is the greatly increased risk of suffering a heart attack and/or stroke, triggered by a much poorer metabolism, too high blood pressure and insufficient oxygen supply or exchange.

CPAP therapy does not eliminate the cause, but only helps at night with additional oxygen supply. During the day, one is left yawning alone.

During my research (internet, phone calls, emails) for alternatives to CPAP therapy, which was spurred on by my own increasing dissatisfaction, I came across, among other things, the probably only possibility to eliminate the actual cause (the obstruction) and to cure the sleep apnea in the Seegartenklinik Heidelberg.

After very detailed and comprehensive consultations and many examinations in the Seegartenklinik (among others with the surgeon, Dr. Frey) and after discussions with affected patients, I could bring myself to have the non-trivial surgery performed.

The consultations enlightened me both medically and in terms of risks, fears and my skepticism. My existing concerns and uncertainties were completely removed. The clinic makes a point of including relatives (in my case my wife) in the consultations and preliminary examinations if they wish.

The surgery is unquestionably a considerable intervention. The surgeon has the highest rate in Germany - on average 100 surgeries per year - and thus the highest experience.

In this surgery, the upper and lower jaws are moved forward to multiply the air passage cross-section in the pharynx. In my case, the jaws were shifted forward by 20mm (plus rotation) and thus demonstrably (proof by three-dimensional images before and after the surgery) generated 800 to 1000% of the previous cross-section.

The immediate post-operative period is very to extremely uncomfortable, but very well cared for, you stay in the clinic for about a week. In the time until the removal of the metals, you are well monitored and cared for by the clinic through regular checks.

An immediately noticeable effect was my extremely good breathing. I got more air than ever before. At the end of the first week of surgery, I went for a walk up a mountain without wheezing, without any shortness of breath.

In the meantime, I can say (after about five months) that the restrictions in eating, the swelling and pain are displaced by the positive results.

Already now it is clear:

• Quiet and restful sleep, completely without snoring (!!!).
• Deep and unrestricted breathing
• No more daytime fatigue
• My blood pressure is back to normal
• Higher motivation for the day
• Better condition

In society - and unfortunately also among a part of the medical profession - the elimination of causes by MMA is judged skeptically or it is even unknown.

I would hereby like to call upon all those concerned:

Inform yourself critically and uninfluenced with as many sources as possible and keep the so-called "common sense" to come to a decision that convinces you and that is the best and therefore healthiest for you.

Personally, I can only advise everyone to decide for this MMA surgery after a detailed consultation, where one is seriously informed about all risks and consequences, if they themselves are convinced of it and have a good feeling about it.

I would do it again!

Ralf Nuremberger