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My Dr. Hockel results and decision to proceed

Ok, so having gone through that episode with the kids, I’ll rewind a bit and talk about what Dr. Hockel said about me. So I got photos and a diagnostic CBCT which allows them to look at your airway and see all the structures.

First of all, is my profile.

Notice how I crook my head weirdly forward and up? It’s compensating for my tiny airway to try to angle in the most air. It also means that every year I had chronic neck pain and had to see a chiropractor every few months to get it addressed. My shoulders are tense constantly. But the chin being far back vs the ideal profile in black hints at the larger issue.

Here’s my CBCT airway scan. Shown as a slice here, but the values are calculated in 3D.

Minimum Axial airway 28mm2. That my friends is tiny, if approximated as a circle it would be about 3mm radius, a drinking straw. Target for an adult turns out to be >200mm^2 (8mm radius, or four boba straws put together) which puts me at an order of magnitude below. Yep, definitely had a problem.

It gets better though. So, turns out with chronic mouth breathing you also place stress on your jaw joints.

What you’re looking at is the interface between the jaw joint and the skull. See that nice bird shape? Tricked you! It’s actually terrible. The shape is driven by uneven wearing due to my mouth hanging open. My jaw joint was awful. Further MRI, later ordered by oral maxillofacial surgeon Dr. Reza Movahed in St. Louis, would confirm that the joint completely slipped.

There are many other bits of data but I’ll gloss over it for the sake of getting to the point. But Dr. Hockel was clear on the matter. He had a long term understanding of airway and said MMA surgery would likely be the only way to proceed if I really wanted to fix it. His working relationship was strong with Dr. Movahed as the OMS of choice. He knew him well enough to see that based on my scans, MMA surgery would probably be Movahed’s recommendation too. At this point I had to take a pause. This was a lot to think about.

Well now I started thinking about it more. Yes, the CPAP could get me some good sleep at night. Annoyance at it was not the reason to jump into large surgery. However, I was easily short of breath in any physical exertion. I wanted to take up swimming but could never get a good enough inhale. I would later read journal articles on the link between poor airway and hypertension, how much it made your heart work harder, even acid reflux, which I had. I can’t quote of any of those for now but the point is my very limited mouth breathing had and would continue to have huge long term impacts on my health. Additionally, the fact that my joint was gone meant chronic TMJ pain risk was a ticking time bomb.

A prayer, a confirmation, and then away I went deciding to go through.

I marched into Dr. Hockel’s office at my next visit, and told him, “I’m gonna do the surgery next summer.” I scheduled the initial consult with Dr. Movahed in St. Louis for the following month but I wanted to get started right away. Dr. Hockel noted that he always sets the teeth straight and gets a wider bottom expansion first. So based on my commitment we started braces that very day.

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