Friday, March 21, 2014

More Tongue Reduction Issues...

When you see the before and after images of Micaelyn it would be easy to assume she had the tongue reduction surgery for cosmetic reasons.  However there were actually more significant reasons for her to have the surgery.

Before the surgery Micaelyn had many signs of sleep apnea.  She snored.  She didn't sleep well and was very restless through the night.  She would wake up acting very confused and never seemed well rested.  She would sweat profusely during her sleep.  She would sleep in strange positions.  These are just some of the signs she exhibited that indicated her enlarged tongue was obstructing her airway during sleep, and this was the most critical factor in deciding to have her undergo the surgery.

Before the surgery Micaelyn was also developing a noticeable underbite, a result of her lower jaw growing forward to accommodate her enlarged tongue.  She also had tooth splaying on her upper jaw as a result of the tongue pushing on her teeth.  If she had not received the surgery at a young age she would most likely have needed jaw surgery by the time she was a teen to correct a severe underbite, and she would have needed a lot of additional orthodontic treatment.  She would also have to have the tongue reduction surgery along with the jaw surgery to prevent problems from developing again with her jaws.  We figured having tongue reduction surgery as a preschooler would be far preferable to having both tongue reduction and jaw surgery as a teenager.

Another great benefit of the surgery is that the growing pains she so frequently had almost completely disappeared.  She used to have severe growing pains.  She would wake up screaming from extreme pain most nights.  Almost every evening she was would complain of her legs hurting, sometimes her arms as well.  Often the pain was very intense - she couldn't even walk at times and would literally be crying out in pain.  We always figured perhaps the overgrowth aspect of BWS was the best explanation for such severe growing pains.  That they almost completely disappeared after surgery made us think that while the overgrowth condition may have made her more susceptible to the growing pains the bigger factor may have been oxidation deprivation due to her tongue blocking her airway.
Micaelyn frequently slept in this position before surgery.  Although it's similar to the position babies sleep in, notice her rear is significantly elevated above the rest of her body.  This is a common sleeping position for kids with obstructive sleep apnea.  Micaelyn was 4 1/2 in this picture.  After the surgery her sleep improved dramatically.

Before surgery Micaelyn would almost always wake up completely drenched in sweat.  This picture was taken after she took a nap of less than an hour.  She was wearing a lightweight sleeveless shirt and shorts, and the house was very cool that day (it was early spring) yet she woke up from the short nap totally soaked in sweat, as you can sort of see in her hair.

Before surgery her tongue noticeably filled her mouth.

This picture was taken while she was still in the hospital recovering from the surgery.   It was amazing to see her tongue fit well enough for her to close her mouth.

Sleeping at home soon after surgery.  The difference in sleep was dramatic!

I don't really have a lot of pictures to really show the underbite she was developing (most of the pictures from before the surgery don't even show any teeth since her tongue was so large) but you can get an idea of it in this profile picture, one of the very few times I caught a picture of her with her mouth closed before surgery.
The force of Micaelyn's enlarged tongue was not only pushing her lower jaw forward to create an underbite, it was also causing splaying in her upper teeth due to the force of the tongue pushing against them.

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