EASE/TPD

 

KR (male 29) – New York, New York

Date of Endoscopically Assisted Surgical Expansion (EASE) – May 16, 2018

Experience: I am better from before the surgery in a major way. Even if I get poor night sleep or like 5 or 6 hours. I am way better than the comparison a year ago.

(male 10) – Los Altos Hills, California

Date of Transpalatal Distraction (TPD) – May 9, 2018

Experience from mom: No longer sleepy upon natural wake-up (compared to before). No longer too sleepy to attend after-school sports activities. Market decrease in the temper tantrums/mood swings and anxiety. Easier-going guy now!

MHC (male 13) – Los Altos, California

Date of Transpalatal distraction (TPD) – September 21, 2018

Experience from dad: Enhanced smell, open nasal breathing, improved sleep, better overall emotional well-being.

Gender: Male

Age: 33

Procedure: EASE

Experience:

Short summary: With quite minimal side effects of short duration, this operation significantly improved my nasal and retropalatal obstruction.

Longer version: I have been an extremely light sleeper and suffered from headaches for my whole adult life, but I was only diagnosed with sleep apnea (with an RDI in the severe category) in 2017, after a back injury forced me to change my sleeping position, worsening my OSA and giving me severe daily headaches and insomnia. After failing with CPAP and and oral device, I tried nasal surgery (septoplasty and turbinate reduction) and tongue surgery (radiofrequency ablation), but neither of these helped significantly. After it became clear that my OSA resulted from structural jaw issues, I decided to have jaw surgery with Dr Li. I chose Dr Li as my surgeon, even though I am located in another state, for a number of reasons: recommendations from former patients who praise his surgical skill; his directness and realism in answering questions; his vast knowledge of sleep apnea; his detailed responses to emails; his ability to accurately explain unusual symptoms and outcomes (e.g. my continued nasal obstruction after nasal surgery, due to maxillary deficiency).

I had the EASE surgery (along with the removal of three wisdom teeth) in late October 2018, and plan to have the MMA later this year (it is now mid-January 2019). The period directly after the surgery was quite difficult for me (apparently to an unusual degree), mainly because of the pain from the removal of wisdom teeth. Before the surgery I was already suffering from bad facial pain every day – the wisdom teeth removal, and perhaps also the EASE, exacerbated this pain. The other post-surgery problem I had was a couple of incidents of bleeding from the incision sites – but this was quite easily controlled, and Dr Li was very helpful when this happened. Because of my extremely narrow maxilla, the distractor bar had to be repositioned a couple of weeks after the operation – this was a very minor and easy procedure.

After the bar was repositioned, and I was able to expand more successfully, I began noticing improvements in my breathing and sleep very quickly. The most noticeable thing was a significant opening towards the back of my nose, and in my retropalatal area – it was as though what had been a narrow straw was turned into a large chamber, which air could rush into. This was a wonderful and novel sensation! I found that I could breathe much better through my nose during the day, and I began to wake up less during the night and to feel less exhausted in the mornings. My daytime headaches reduced significantly.

It has now been three months since the EASE procedure, and I am very pleased with the outcome. In terms of sleep, I was starting off from a very low base – before the operation, I was sleeping absolutely terribly, to the extent that I felt desperately tired every day; since the operation, I still sleep poorly, but noticeably better than before. The improvement in my daytime breathing and headaches has also been very pleasing. What I think is most impressive is the level of improvement this operation produces in relation to its invasiveness. After the difficult first couple of weeks, the operation had no significant side effects or complications, and yet it has really helped – the other minimally invasive procedures I tried with different doctors (nasal surgery and tongue radiofrequency) were actually more difficult, and produced much less benefit.

So, overall, I would rate this procedure very highly. In my own case, as I expected before the procedure, I still need additional surgery – the MMA – in order to improve my sleep to a more tolerable level and to fix my bite, but I think in less severe cases (or those where the patient is able to comply with CPAP after the operation) the EASE alone could be sufficient. In addition to the benefits of the surgery itself, the other thing I would mention is the extremely impressive level of involvement and attention Dr Li shows towards patients. He was in regular contact with me during the expansion process via cellphone, responded to messages very quickly, and when problems (such as bleeding) arose he called almost as soon as I messaged him, provided calm and effective guidance, then checked on me regularly. I would recommend any patient with sleep apnea to consult Dr Li – for his exceptional diagnostic insight, superb surgical inventiveness and skill, and genuine care for patients, manifested in a level of pre- and post-surgical follow-up superior to anything I have encountered in other medical settings.

SBW (female 63) – Menlo Park, California

Date of Endoscopically Assisted Surgical Expansion (EASE) – March 13, 2019

Experience:

I met Dr Li when he treated my teenage daughter, which resulted in a life changing outcome that reduced her severe sleep apnea to near normal levels. I credit a part of the success to the integrated approach that Dr Li took in collaborating with Drs. Stacy Quo and Carmen Choy.

I am a 63 year old female who was diagnosed with moderate sleep apnea and a deviated septum. I am very active, not overweight but had trouble feeling rested after sleep unless I engaged in intense exercise on a daily basis. I was prescribed a BiPap (similar to a CPAP) which provided sub-optimal relief of symptoms.

In March 2019 Dr Li performed an outpatient surgery to correct my deviated septum and insert a transpalatal distractor (TPD). Because Stanford hospital did not accept my insurance Dr Li and his team worked tirelessly to help identify and schedule the surgery at an in-network out-patient clinic. Recovery from the initial surgery took more time than I expected to recover due to swelling, but pain medication and regular icing, followed by soft food made the procedure and recovery smooth, albeit longer than for my teenage daughter. Note: don’t delay in getting this surgery if you are over 50 years of age. After one month Dr Li assessed that the bar placement was not allowing expansion of the palette and the TPD was removed in his office in a procedure similar to filling minor cavities. I noticed that my breathing had improved as a result of straightening of my septum, but I continued to use the BiPAP, which I found challenging due to allergies and nasal congestion.

One month later Dr Li installed the TPD in his office in a one hour procedure that was much more straightforward and with a quicker recovery than the out-patient clinic procedure. Expansion of the TPD started 10 days later and was very simple and effective. 6-8 weeks after surgery I noticed that central hypoptic events on the BiPAP were unusually high, an indication that my breathing had changed. Dr Li recommended lowering the BiPAP pressures twice over the course of the expansion. The expansion continued out to 3 months post-op and I started to note a significant improvement in my sleep. The expander was removed in a simple in-office procedure 5.5 months after insertion.

I am feeling much more refreshed and rested, to the point that I stopped using my BiPAP because I noted little to no improvement from the device. I carried out an in-clinic sleep study and my Hypoptic Index (HI) has decreased from 25 to 9, which is a changed from moderate to mild sleep apnea. Without trying I lost 10 pounds, which I attribute to improved sleep and lack of late night snacking that has always been a way of dealing with not getting enough rest.

I would highly recommend Dr Li and his colleagues if you have any sleep problems. I was told by the head of the Stanford sleep clinic that Dr Li is the only surgeon in North America he would allow to perform the MMA surgery on. My daughter and I found that Dr Li’s descriptions of procedures were always very clear, he was always available to answer questions (even over the holidays) and his team was extremely supportive. While surgery is never fun Dr Li’s skill and passion for his practice and compassion for his patients made the outcome well worth the inconvenience that surgery and recuperation entail.

I would be happy to speak with anyone considering treatment by Dr Li.