The Sleep Apnea Surgical Option: An effective and viable alternative to CPAP and MADs

If you’ve been diagnosed with Obstructive Sleep Apnea (OSA), you’re likely familiar with the CPAP machine, which is widely considered to be the first line of defense for OSA.  However, for many, CPAP is uncomfortable, awkward and even claustrophobic.  As a result, there are many CPAP machines that are just sitting and collecting dust.

If you’ve been diagnosed with Obstructive Sleep Apnea (OSA), you’re likely familiar with the CPAP machine, which is widely considered to be the first line of defense for OSA.  However, for many, CPAP is uncomfortable, awkward and even claustrophobic.  As a result, there are many CPAP machines that are just sitting and collecting dust.

A second option for OSA treatment, commonly recommended as an alternative when CPAP is not tolerated, is a custom-made oral appliance. Also known as a Mandibular Advancement Device (MAD), the appliance opens the airway by moving your mandible (lower jaw) forward, which in turn also brings your tongue forward.  However, as with CPAP, there are many who can’t tolerate an oral appliance – especially those who also suffer from TMJ problems.  Even for those with mild TMJ problems, an oral device can exacerbate the problem.

Sleep Apnea and Snoring

A common symptom and possible indicator of OSA is loud snoring. However, most people don’t know that you can still have sleep apnea without snoring.   And that can lead to serious health issues.  In other words, an oral appliance could very well eliminate your snoring, which leads you to think that your OSA is resolved.  However, the MAD could actually be masking the symptoms – without treating the disease.  This is sometimes referred to as silent sleep apnea.

Benefits of Surgery for OSA

When neither CPAP nor an oral appliance works for you, what else can you do to help prevent the disruptive and potentially severe and life threatening effects of OSA?  For many, that’s the surgical option.  The benefits of the surgical option include:

  • Permanence: For patients with mild and even severe sleep apnea, surgery can be a permanent solution. Although it’s always a possibility that OSA may return, the surgical option is geared at providing a permanent anatomical fix to the issue causing your OSA.
  • Effectiveness: Even if the surgical option doesn’t completely resolve your OSA, it can still be very effective in reducing the severity of your OSA. In fact, it’s not unusual for surgery to result in a 50% drop in the Apnea-Hyopnea Index (AHI), the measure used to indicate the severity of OSA.  For example, if your AHI pre-surgery level is at 40 (severe apnea) and then drops to 9 (mild apnea) post-surgery, that’s a significant improvement.
  • Convenience: If surgery does reduce the level of your OSA, you’ll no longer have to deal with the inconvenience of a CPAP or MAD if you have been using them for treatment.  A surgical solution means no more devices at home or when you travel.
  • Peace-of-mind: Most of all, a surgical solution, when successful, will let you literally and figuratively breathe easier, knowing that the risk of serious side effects of OSA has been significantly diminished.  It means better sleep, increased energy – and a reduced risk of cardiac problems associated with OSA.

Surgical Options for OSA

There are three surgical options that are typically the most effective when treating OSA.  It’s essential to keep in mind that no matter what option you choose, the surgery should be performed only by a Board Certified Oral and Maxillofacial Surgeon with extensive experience in OSA surgical procedures and protocol.  The three surgical options are:

  • Genioglossus Advancement

Genioglossus Advancement prevents upper airway blockage by preventing the tongue to collapse toward the back of the throat during sleep. The genioglossus is the primary muscle of the tongue and is attached to a small bony projection on the interior of the lower jaw. During this surgery, this small bone projection is moved forward and the tongue attachment is repositioned anteriorly so that it is less likely to collapse posteriorly and block the airway during sleep.

  • Hyoid Advancement:

The hyoid bone is a small bone under your chin, which is advanced to treat tongue-based obstructions by expanding the airway. This surgery is often done in combination with a Genioglossus Advancement, as it has been shown that this combined approach increases the overall success of the treatment of sleep apnea.

  • Maxillomandibular Advancement:

Maxillomandibular Advancement is the most effective and reliable treatment for patients with severe obstructive sleep apnea. This sleep apnea surgery involves moving the upper and lower jaws forward, thereby enlarging the entire airway. The treatment procedure is performed on patients with moderate to severe OSA as the only treatment, or when other procedures have failed.  It is also sometimes combined with a chin advancement to maximize the enlargement of the airway space.

Maxillomandibular advancement has been shown to significantly increase airway dimensions in both lateral and anterioposterior directions. Maxillomandibular advancement surgery has been shown to have a success rate as high as 90% in the treatment of sleep apnea.

Determining if surgery is right for you

If you’re suffering from the symptoms of OSA –- including daytime fatigue and nighttime snoring –- it’s important to schedule a sleep study at your earliest convenience.  A sleep study will help determine if you do have apnea, and if so, the level of its severity.

When considering surgical options to treat your OSA, it is important to note that surgery is not considered the first line of treatment.  If diagnosed with OSA, it’s likely that your physician will recommend that you first try CPAP or an oral appliance.  Both of these options do work for many patients.  However, if they don’t work for you, surgical options should be explored with your physician.   In order to determine if you are a candidate for surgical treatment, your physician may order a CT scan and/or a sleep endoscopy.

Don’t give up…see your physician today!

If you’ve already been diagnosed with OSA and neither CPAP nor a MAD have worked for you, it’s critical that you don’t give up – because OSA can cause serious health issues, even heart failure if left untreated.

 

Ruben Cohen, D.D.S. is a Diplomate of the American Board of Oral and Maxillofacial Surgery. Dr. Cohen is the founder of Park Avenue Oral & Facial Surgery, P.C., located in the Upper East Side of New York City.

For more information on Dr. Cohen’s sleep apnea treatment options, including surgery and custom oral appliances, please visit his website at www.ParkAvenueFaces.com.

 

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Knock-Out Dental Anxiety For Good

Dental visits can be one of the most anxiety causing events in a person’s life. Maybe it’s because of a traumatic visit while you were a child, or because you have particularly sensitive teeth. Regardless, maintaining a healthy smile is important to your overall health. That’s just one reason why we are pleased to offer sedation dentistry at all of our locations

Dental visits can be one of the most anxiety causing events in a person’s life. Maybe it’s because of a traumatic visit while you were a child, or because you have particularly sensitive teeth. Regardless, maintaining a healthy smile is important to your overall health. That’s just one reason why we are pleased to offer sedation dentistry at all of our locations.

Sleep Through It All

Sleeping through your dental appointment sounds like a dream, right?  But it’s not only  possible, it’s also desirable if you have a long involved treatment coming up. There are three levels, each with their own benefits:

Nitrous Oxide: A mild level of relaxation, perfect for a cleaning or minor filling. Too much nitrous can have the opposite effect of relaxation, and put you on edge. A low level is just right.

IV Sedation: Also called “twilight sleep”, this is when patients are sedated, but they can still respond to the dentist but not actually remember the procedure.  Patients are monitored at all times to ensure safety.  You may still be compliant with commands, but will probably fall asleep. You may still be aware of pressure.

General Anesthesia: Medication are administered through an IV line although inhaled anesthetics may also be used.  The main difference between IV sedation and general anesthesia is the level of sedation. General anesthesia is usually used for patients requiring a deeper level of sedation.  It is most helpful for infants, patients who require major treatment or who are extremely anxious, or for patients who are medically compromised of have special needs.

At Park Avenue Oral & Facial Surgery, we are committed to a comfortable, worry free dental or oral surgery visit. Schedule your appointment with Dr. Cohen today.

Traumatic Injuries Require Specialized Care

Imagine: You’ve been in a car accident. You’re alive, but the airbag didn’t deploy right, so your cheek is crushed and you have lacerations near your eyes.  You need a maxillofacial surgeon to repair your bones and tend to your mouth, but how are you going to find the right doctor?

Imagine: You’ve been in a car accident. You’re alive, but the airbag didn’t deploy right, so your cheek is crushed and you have lacerations near your eyes.  You need a maxillofacial surgeon to repair your bones and tend to your mouth, but how are you going to find the right doctor?

What to Look For In A Surgeon

  • Look at certifications: No matter what specialty you are looking for, you want to find a board-certified surgeon. For facial trauma, you need either a maxillofacial surgeon or a plastic surgeon.
  • Where does he practice? Surgery should be performed in an accredited or professionally sponsored hospital or surgical center to ensure the highest standards of care.

Certified in maxillofacial and oral surgery, Dr. Cohen is able to diagnose and repair damage to all facial structures and mouth. As a Fellow of both the American Association of Oral & Maxillofacial Surgeons and the American Dental Society of Anesthesiology, he maintains rigorous standards of care. He is appointed to practice at six hospitals in the New York area. Moreover, he understands the physical and emotional toll of facial trauma and does everything possible to return functionality and aesthetically pleasing proportions to each of his patients.

More than physical trauma

Traumatic facial injuries are debilitating both physically and psychologically. You need a doctor who  will give your face the best chance to recover, so you can work on the emotional trauma. Dr. Cohen at Park Avenue Oral & Facial Surgery has had extensive training in maxillofacial trauma.  Call our Park Avenue office today for a consultation to start the road to recovery.

New York Oral & Facial Surgery, L.L.C. earns AAAASF accreditation for patient safety

CHICAGO, IL — New York Oral & Facial Surgery, L.L.C., in New York, NY has demonstrated its commitment to patient safety by gaining accreditation from the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) for the second time in a row. AAAASF is celebrating its 37th year of promoting the highest quality patient safety in the ambulatory surgery setting (office-based or outpatient), as well as rehabilitation and outpatient therapy agencies and rural health clinics.

For immediate release: July 3, 2017

Contact: Marketing Director, Lisa Stichert

Phone: 847-775-7915

Email: lstichert@aaaasf.org

 

New York Oral & Facial Surgery, L.L.C. earns AAAASF accreditation for patient safety

 

CHICAGO, IL — New York Oral & Facial Surgery, L.L.C., in New York, NY has demonstrated its commitment to patient safety by gaining accreditation from the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) for the second time in a row. AAAASF is celebrating its 37th year of promoting the highest quality patient safety in the ambulatory surgery setting (office-based or outpatient), as well as rehabilitation and outpatient therapy agencies and rural health clinics.

AAAASF requires 100 percent compliance with all accreditation standards and does not offer partial accreditation. If a facility fails to meet any standard, it must correct the deficiency or risk denial or loss of accreditation.

To earn its accreditation, New York Oral & Facial Surgery, L.L. C. passed inspection on hundreds of important criteria concerning patient safety. AAAASF facility surveyors are board certified medical specialists trained to perform a thorough and complete facility inspection. AAAASF facility surveyors follow a regimented procedure to survey an outpatient surgery facility in the following categories:

  • General Environment
  • Operating Room Environment, Policy and Procedures
  • Recovery Room Environment, Policy and Procedures
  • General Safety in the Facility
  • Blood and Medications
  • Medical Records
  • Quality Assessment and Quality Improvement
  • Personnel
  • Anesthesia

 

About the AAAASF

The American Association for Accreditation of Ambulatory Surgery Facilities, Inc. (AAAASF) was established in 1980 to standardize and improve the quality of medical and surgical care in outpatient facilities and assure the public that patient safety is top priority in an accredited facility. More than 2,200 outpatient facilities are accredited by AAAASF, one of the largest not-for-profit accrediting organizations in the United States. Surgeons, legislators, state and national health agencies and patients acknowledge that AAAASF sets the “gold standard” for quality patient care.

AAAASF programs include surgical, procedural, oral maxillofacial, international surgical and dental. AAAASF is also deemed by Medicare to accredit ambulatory surgery centers, rehabilitation and outpatient therapy agencies and rural health clinics. For more information, visit http://www.aaaasf.org or Facebook, LinkedIn and Twitter.

 

New York Oral & Facial Surgery, L.L.C. is the facility for Park Avenue Oral & Facial Surgery, P.C., Park Smiles NYC, and Park Smiles NYC Pediatrics.   Our two facilities are conveniently located in the Upper East Side of Manhattan, and accredited by AAAASF.  Our first office is located at 970 Park Avenue, New York, NY  10028 (at the corner of 83rd Street).  Our second office is located at 1175 Park Avenue, New York, NY  10128 (at the corner of 93rd Street).  We are dedicated to offering a comprehensive array of the very best dental services in New York in one convenient location.  For more information, please visit www.ParkSmilesNYC.com for our comprehensive dental practice, www.ParkAvenueFaces.com for our oral & maxillofacial surgery practice, and www.ParkSmilesNYCPeridatrics.com for our pediatric dental practice.

 

 

Four Signs Your Teen Needs Her 3rd Molars Removed

Conventional dentistry indicates that wisdom teeth should be removed early, but recently, many dental professionals argue that the third molars can be healthy and should not be automatically considered for removal. The truth lies somewhere in the middle.

Four Signs Your Teen Needs Her 3rd Molars Removed

Conventional dentistry indicates that wisdom teeth should be removed early, but recently, many dental professionals argue that the third molars can be healthy and should not be automatically considered for removal. The truth lies somewhere in the middle.

Here are some of the warning signs you should watch for in your teen to help you know when to see the dentist about wisdom teeth:

Chronic Sinus Pain: As upper third molars grow and erupt, they can become swollen and infected. The pain may be referred back into the sinuses. This could be a difficult diagnosis if your child also has allergies, as a medical doctor may simply treat for a sinus infection. Full facial imaging can help determine the true cause.

Jaw and Mouth Pain: Unerupted third molars tend to put pressure back into the jaw. It may hurt to open and close, causing symptoms like temporomandibular disorder (TMD.) Patients may also experience pain, swelling, or redness in the back of their mouth where the wisdom teeth are located.  However, when those teeth begin to erupt, they hurt the mouth, too. Part of this is regular teething pain, but the other part is because…

Wisdom Teeth Don’t Always Come in All the Way. If your teen’s wisdom teeth have only come in part way and the gum is still covering a portion of it, they may need to be extracted.  Leaving it in place will only allow bacteria and food particles to slide under the gums, which creates infection, cavities and deterioration of the surrounding bone and teeth.

Chronic Bad Breath.  Teens are not the most hygienic people. But if you know your teen does regularly brush and floss, that bad breath could be symptomatic of inflammation and infection in the are of the wisdom teeth.

At Park Avenue Oral & Facial Surgery, we can determine if your teenager’s wisdom teeth are growing straight or if they are or will be impacted, requiring extraction. Call our Manhattan office today for a consultation and help get your teen’s teeth healthy.

Wisdom Tooth Removal for 30-Somethings

There is a dull ache in your jaw; you feel it when you chew. When you run your tongue over your teeth, you can feel the same ache (and maybe even a bad taste) coming from those back teeth. You know the ones…

There is a dull ache in your jaw; you feel it when you chew. When you run your tongue over your teeth, you can feel the same ache (and maybe even a bad taste) coming from those back teeth.  You know the ones. You were just out of college when they started to break through, but after several years they never really came in all the way. They’re shorter, and maybe they feel like they “lean” into your other teeth.  It’s your “wisdom teeth” that are causing all of the pain.

Why Are They Causing Problems Now?

 Not everyone will have problems with their third molars, or wisdom teeth. For a small number of people, the teeth grow in straight and without issue.  An even smaller group of folks never get them at all. But for everyone else, those molars can cause problems. It starts when the teeth begin to push up. The third molars are often positioned at an angle, so the upward movement ends up impacting against the roots of the next molars that are already fully formed.  Since there’s no room to finish moving up, the growth process stops with part of the tooth remaining under the gumline.

Needless to say, this is a precarious position for your dental health.  Anything you eat will leave food particles and bacteria trapped under the gum on the tooth.  No amount of brushing will remove it. Eventually, decay will set in and affect the roots of the wisdom tooth as well as the molar it’s next to.

Infection and tooth decay do not get better or reverse themselves with time. That dull ache you’re feeling is your body’s warning system. That’s when it may be best to proactively remove your wisdom teeth.

At Park Avenue Oral & Facial Surgery, we provide comprehensive oral surgery services, including wisdom tooth removal for results.  We’ll remove your impacted wisdom teeth under IV sedation in our AAAASF-accredited ambulatory surgical facility, providing you with a solution to keep the rest of your smile healthy.  Call our NYC office today for an appointment!

 

PRESS RELEASE: New York Times Magazine announces Dr. Ruben Cohen as one of the top 20 Oral Surgeons in NYC!

In the May 14, 2017 edition of The New York Times Magazine, it was announced that Dr. Ruben Cohen, an esteemed board certified Oral and Maxillofacial Surgeon, has been selected by his peers as one of the top 20 Oral Surgeons in New York City.

 FOR IMMEDIATE RELEASE:   May 15, 2017

New York Times Magazine announces Dr. Ruben Cohen as one of the top 20 Oral Surgeons in NYC!

In the May 14, 2017 edition of The New York Times Magazine, it was announced that Dr. Ruben Cohen, an esteemed board certified Oral and Maxillofacial Surgeon, has been selected by his peers as one of the top 20 Oral Surgeons in New York City.

When healthcare consumers requested a list of the top Oral and Maxillofacial Surgeons in New York, The Times asked their selected New York Super Doctors for help.  Alumni physicians of the renowned group were asked to name candidates to whom they would go to or refer their own patients or loved ones for care.  The process for this first-ever “Super Specialists” list included peer nomination and independent research on the candidates including professional achievement.

Born in France, Dr. Cohen grew up in Paris and Los Angeles.  No stranger to awards and accolades, Dr. Cohen takes special pride in his volunteer work across the world to provide free surgical treatment to children born with facial deformities.  Dr. Cohen’s volunteer and community work includes:

  • Israeli Defense Force, Medical Corps HospitalPort-au-Prince, Haiti Volunteer: Oral & maxillofacial surgeon at the IDF Medical Field Hospital after the 2010 earthquake.
  • Dental Volunteers for IsraelJerusalem, Israel Participant: Volunteered as an oral & maxillofacial surgeon at the Trudi Birger Dental Clinic.
  • Little Baby Face FoundationNew York, NY Medical Advisory Board: Volunteer to provide corrective facial surgery to children in financial need. Children are flown to NYC from other states or countries.
  • Interplast-GermanyParticipant: Travel with a team of German plastic surgeons, anesthesiologists, and oral & maxillofacial surgeons to remote villages in Africa & Asia to provide cleft lip & palate repair.
  • Miracle Corners of the World, Inc.Tanzania, East Africa Project Coordinator: Organized and set up a dental clinic in East Africa, which provides free dental care to disadvantaged children and adults.

Dr. Cohen is the founder of Park Avenue Oral & Facial Surgery, P.C., Manhattan’s premier oral and maxillofacial surgery practice located at 970 Park Avenue.  He is also the founder of Park Smiles NYC and Park Smiles for Kids at 1175 Park Avenue, a family-friendly dental practice featuring comprehensive dental services for patients of all ages under one roof.

Contact:  Dr. Ruben Cohen – Park Avenue Oral & Facial Surgery – 212-988-6725

http://www.parkavenuefaces.com/     info@parkavenuefaces.com

Facial Implant Options for Reconstruction and Aesthetics

You have a thin jaw, no chin, or maybe even an overbite. Perhaps some of your face feels sunken-in as well, especially due to tooth and bone loss over time. Finally, you’re considering taking extra steps to enhance your facial profile. After all, you want the reflection in the mirror to look as young as you feel.

At this point you’re probably wondering…what more can you do?

Opting for a Different Kind of Implant

At Park Avenue Oral & Facial Surgery, we offer more than routine oral surgery and dental implants. Our board-certified surgeons can also help you to correct the shape of your jaw and profile with cosmetic implants. These implants serve a visual purpose, as they fill out your facial features in areas where the bone appears shorter or shallower than it should.

One such device is the chin implant. When inserted at the front of your mandible, it aids in creating a fuller, more defined jaw and facial profile, without traditional jaw surgery. It’s a simple process that promises noticeable results.

Another type of facial implant is the mandibular angle implant. These implants are placed in the back of the lower jaw, squaring off a narrow, undefined jaw.  The combination of chin and jaw implant can also work together to make a more aesthetically pleasing facial profile.

Your Oral Surgery and Implant Experts

At Park Avenue Oral & Facial Surgery, we understand that there are multiple facets that need to be considered when enhancing your oral health, bite, and appearance.  Our board-certified oral and maxillofacial surgeon will work closely with the rest of our highly experienced team to provide you with the latest in mandibular angle and chin implant treatments, so that you can enjoy the confidence of a beautiful profile that brings out your true personality. Call us today for a consultation.

Dental Implants for Unconventional Patients

Have you ever had a dentist tell you that you weren’t a candidate for dental implants? It may be partially true…but it could just be that your dentist didn’t have the capabilities of using modified implant techniques or variety of implant designs that would work.

One of the most common reasons why people are told they are “not candidates for implants” is because of bone loss that occurs following the removal of teeth. A jaw that is too thin or has resorbed (shrunk away) cannot support a traditional type of implant.

At Park Avenue Oral and Facial Surgery, we use modified placement protocols and implant designs to change the way the artificial “roots” are installed. For instance, a longer, more slender design may be placed at a different angle in the jaw. This allows us to maximize the use of healthy bone structure, rather than try to work in compromised areas. The results offer the same great stability and smile rehabilitation as other implants.

Trusting an Expert With Your Smile

Implants ought to last forever. Our board certified oral and maxillofacial surgeon knows exactly what it takes to place different varieties of implants in various areas of the mouth. After all, it’s a complex process and not something that a general family dentist would generally be familiar with performing. Even if your entire smile needs to be restored, dental implants with an oral surgeon are almost always a possibility.

Our state-of-the-art facility offers services such as sedation dentistry, so that you can relax from the start of the procedure to the finish. Your comfort and oral health are our top priorities.

Stop hiding your smile or struggling with that uncomfortable denture. Contact Park Avenue Oral and Facial Surgery to speak to one of our specialists about implant options that are available to fit your needs.

Common Reasons for Having Wisdom Teeth Removed

Wisdom teeth are often a rite of passage into adulthood. The reason for having the 3rd molars removed will vary from person to person. Our New York City oral surgeon frequently performs wisdom tooth removal for situations such as:

Common Reasons for Having Wisdom Teeth Removed

Wisdom teeth are often a rite of passage into adulthood. The reason for having the 3rd molars removed will vary from person to person. Our New York City oral surgeon frequently performs wisdom tooth removal for situations such as:

Pain and/or Swelling

Do you notice discomfort or swelling at the back of your mouth or in your jaws? Does it seem to come and go? Your wisdom teeth could be the cause. Most people tend to find that the pain just will not go away unless we remove the teeth altogether.

Impacted (Misaligned) Wisdom Teeth

Depending on your oral anatomy, your jaws may not have any room for the wisdom teeth to properly erupt. Or, the teeth are growing at an odd angle that prevents them from erupting at all.

In many situations, the wisdom tooth will only partially erupt. When that’s the case, we often see that the tooth develops cavities or gum disease around it because of how challenging it is to clean. If we see an infected wisdom tooth, it is almost always in your best interest to have it removed as opposed to trying to keep the tooth healthy for decades to come.

Pressure on Adjacent Teeth

As your wisdom teeth form, they can start to push against the teeth next to them If you’ve worn braces, one of the first things that you might notice is how your front teeth are starting to crowd together again. The pressure could even damage, or in rare cases kill the healthy tooth next to your developing molar.

At Park Avenue Oral and Facial Surgery, our board-certified oral surgeon has removed thousands of wisdom teeth in NYC. We also provide safe and gentle sedation options to help you relax through the procedure. Schedule your consultation with our New York City wisdom tooth specialist today to learn more.