Featured Patient Experiences

FEATURED CASE 07/20: Snoring & Sleep Apnea

Patient:

Doug

The problem:

“I snore and my wife cannot sleep”

Patient History:

photo of a couple with husband having Snoring & Sleep Apnea problems
  • Doug is a 37-year-old male with a history of loud snoring.
  • He notes that it has affected his wife’s sleep and impacted their relationship.
  • He noted having to sleep in another room on many occasions.
  • It was his desire to simply decrease his snoring and improve the quality of his wife’s and his lives.

Pertinent Information:

  • Snoring is noisy breathing created by air turbulence along with the airway anatomy while you sleep.
  • Commonly associated factors include restricted nasal passages, the poor muscle tone of the throat and tongue, large-sized tongue and throat tissue, long soft palate and uvula, excessive alcohol use, and sleep position.
  • It is a very common condition that affects both males and females but males are more affected.
  • Increasing weight and age are significant factors in addition to deformities of the jaw (retrusive), tongue (large), palate (long), face, and neck (large).
  • Although snoring is not a direct health emergency, it most frequently is a nuisance for one’s bed partner and a primary reason for patients seeking care.
  • Long-term snoring can affect sleep patterns and may be associated with Obstructive Sleep apnea (disturbances in breathing when asleep).
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Exam and Diagnosis:

  • Doug underwent a volumetric CT Scan analysis of his airway.
Patient experience Doug volumetric CT Scan analysis of his airway 1
volumetric CT Scan analysis of his airway 2
  • Following the initial consultation, he also received a formal sleep study (polysomnogram) and was determined to have only very mild sleep apnea.
  • His AHI was almost normal. Apnea-Hypopnea Index (AHI) measures sleep apnea severity.
  • The AHI is the sum of the number of apneas (pauses in breathing of at least 10 seconds) plus the number of hypopneas (periods of shallow breathing) that occur, on average, each hour.
  • Doug was determined to have primary snoring and did not seek nor require any significant treatment of sleep apnea.
  • We then performed a complete evaluation of Doug’s airway while he was sedated and asleep.
  • This was performed with a tiny (3mm) flexible camera to assess his nose, oral cavity, and throat while sedated to reflect his muscle tone when he sleeps.

This procedure is called Diagnostic Nasopharyngoscopy.Diagnostic Nasopharyngoscopy

Procedures:

  • Nasal Septoplasty (correction of the crooked central portion of the nose)
  • Bilateral Submucous Turbinectomies (reduction of the lateral portions of the internal nose without incisions)
  • Uvuloplatolasty (reduction and reshaping of the uvula and soft palate )
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Commentary:

  • While snoring may not be perceived as a health problem by most patients, it may be a symptom indicative of the bigger problem of Obstructive Sleep Apnea.
  • Proper evaluation and diagnosis must be conducted to differentiate between snoring and obstructive sleep apnea and treatment options designed accordingly.
  • Weight reduction and control can be a very helpful adjunct to sustained treatment success.
  • In our experience, the biggest problem with snoring lies with the bed partner.
  • It is simply torture, to try sleeping next to someone snoring. Snoring impairs the sleep quality of the bed partner and maybe more deleterious on their health.

We were so grateful that Doug was kind enough to share his experience with other patients and even more delighted that we were able to improve the quality of restful sleep for both him and his wife.

David H. Gilbert DDS, MS, MBA, FACS

5 out of 5 stars based on 107 reviews.

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I love this office! Dr.Gilbert is the kindness

- Jana Q

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Doctor Gilbert and his staff are wonderful! I felt at ease when we discussed my condition and the treatment plan was explained in detail. The staff is warm and welcoming and we are grateful for this overall. Thank you Dr. Gilbert and team!

- Isidro H

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Great experience

- Gayle H

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Amazing

- George G

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Good experience and good result so far.

- Elizabeth O

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Staff and MD have always been very friendly & professional. Several family members have had procedures done & we have all been very pleased w/ our services at this office. I would definitely refer others to Dr. Gilbert.

- Deanna V

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Dr. Gilbert is awesome! He thouroughly explained everything & took the time to answer all our questions. All our appointments were right on time. His staff was extremely friendly and professional.

- Michelle F

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great staff and very prof. Doctor

- Laura F

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So happy that my dentist referred me to Dr.Gilbert

- Lesley R

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Very nice visit with no pain or discomfort.

- Donald B

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FEATURED CASE 06/20: Facial Trauma- Dog bite to lip

Patient:

Tyler

The problem:

“I had a dog bite off a piece of my lip”

Patient History:

  • Tyler is a 23-year-old gentleman who was at a friend’s place on Halloween night.
  • His friend’s dog suddenly bit his lip and face resulting in loss of lower lip tissue and puncture wounds to his face.
  • Dr. Gilbert was called to consult and treat his facial injury at a local trauma hospital.

Pre Op Photos:

Procedure:

  • The patient was taken to the operating room for cleaning and repairing his wounds.
  • He underwent delicate plastic repair of his lower lip to reconstruct the lip muscles, skin, and lip line.
  • He was placed on therapeutic and prophylactic antibiotics to combat the potential of infection.

Photos of injury and sutured repair:

Treatment course:

  • The patient was seen and followed very closely by Dr. Gilbert and his team at Inland Institute.
  • Careful attention was paid to care for his wounds, his healing period, and recovery.

Photo of sutures removed and early healing:

Tyler’s Experience:

  • Tyler was very pleased with his healing and final result.
  • He proceeded to resume life as usual with virtually no evidence of his injury.
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Commentary:

  • Facial trauma can present as a result of various mechanisms and present numerous challenges to both the patient and the treatment team.
  • Dog bites are dirty wounds filled with very harmful bacteria. Without proper medical and surgical treatment, it can lead to severe and life-threatening infections.
  • Tissue loss is a frequent finding with dog bites and reconstruction takes various approaches. It is not unusual to have multiple surgeries after trauma.
  • These injuries can be quite dis-figuring. Ultimately, it is the intent of reconstruction to return the patient to as close a pre-trauma condition as possible.
  • Surgical Experience (trauma, cosmetic, and reconstructive) and in-depth knowledge of the face, head, and neck are of utmost importance in these cases.

We are so happy that Tyler had a very cosmetic and functionally natural end result after a single surgical intervention.

Pre and Post Op Photos:


Featured Case 05/20 – Corrective Face/Jaw Surgery

Patient:

Joe

The problem:

“I have an underbite and cannot chew my food. It is impossible to bite a sandwich!”

Patient history:

  • Joe is a 17+-year-old with a developmental facial and jaw deformity
  • He has had progressive challenges eating and speaking
  • His mother relates that it is also very socially challenging as a teenager in school.
  • He looks forward to looking “normal and being able to eat anything he likes”.
  • He was referred by his orthodontists and primary physician for corrective jaw surgery (orthognathic surgery)

Pre Op Photos:

 
 
 
 
 
 

Pertinent information:

Developmental growth deformities of the face and jaws are fairly common. The 2 most concerning issues for patients are aesthetics and chewing function.

It is not uncommon where the upper jaw (maxilla) or lower jaw (mandible) to grow at different rates to each other. This may produce an underbite (lower jaw ahead of upper jaw/ prognathic),  overbite (lower jaw retrusion), or open bite (teeth not touching) mal-occlusion. A bad bite is referred to as a mal-occlusion.

Many cases can be treated by orthodontics (braces) alone but when the jawbones have too much of a discrepancy, corrective jaw surgery may be required.  Corrective jaw surgery (orthognathic surgery) almost always goes hand in hand with orthodontics.

  • The patient starts with braces, followed by surgery, and then a short period of orthodontic fine-tuning.
  • The braces correct the dental discrepancies (crooked teeth) and the surgery corrects the skeletal (jaws, cheeks, nose, etc.) and bite relationship components, to result in balance and harmonious function.
  • Surgery is typically planned after major facial growth ceases. (females >15, males >18 years of age).

This treatment approach addresses and optimizes:

  1. The bite (occlusion)
  2. The airway (breathing)
  3. Aesthetics (facial harmony, balance, proportions, and profile)
  4. Function (chewing/mastication)

All planning is performed using computer-aided diagnostics, design, and manufacturing before embarking on surgery. Surgery is typically performed in a hospital or surgery-center environment under general anesthesia.

Single jaw surgery patients go home the same day and double jaw surgery patients typically stay for about 48 hours before being discharged.

Planning process photos:

 
 
 
 
 
 
 
 

Treatment:

  • Computerized/digital facial analysis and treatment planning with the fabrication of computer-generated surgical guides.
  • Presurgical airway (nose and throat) analysis was performed by using a small guided camera while sedated (naso-pharyngoscopy).
  • Upper jaw surgery (Lefort osteotomy)
  • Lower jaw surgery (bilateral sagittal split osteotomy)
  • Chin augmentation (genioplasty)
  • Cheek implant augmentation
  • Nasal septoplasty

Post Op Photos:

 
 
 
 
 

Commentary:

Admittedly Joe was very self-conscious about his appearance before surgery. It was one of the major driving forces with his decision to have treatment. An interesting concern that may be raised among family members is that they do not want patients to look like a totally different person after surgery. While this surgery is truly transformational, every effort is made to preserve inherent family and patient identity features.

Joe was very pleased with his final aesthetics and functional result. He and his family expressed how much this helped his self-confidence the most, among all the other benefits of this treatment.

Seeing and hearing how much a procedure helps a patient is the best compliment we can receive.

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Before & After Photos Photos:

BEFORE
AFTER
BEFORE
AFTER
BEFORE
AFTER
BEFORE
AFTER

 

Featured Case 04/20 – Aesthetic Dental Implant

Patient:

John

The problem:

“I am missing front teeth and want to replace with teeth that look natural”

Patient history:

  • John is an active and robust 23-year-old gentleman who never developed his maxillary (upper jaw) lateral incisors.
  • He has been wearing a removable retainer to replace his missing teeth.
  • He is very concerned about his appearance and requested the best long-term solution to replace his missing teeth.
 
 

Pertinent information:

Maxillary incisors are among the most frequent developmentally missing teeth. As they are in the most visible location, aesthetics are a major concern for patients. When teeth are missing, the bone shrinks (atrophy), and the adjacent teeth drift into the spaces.

Patients have 4 options when missing teeth:

  1. do nothing,
  2. removable denture,
  3. fixed bridge and
  4. dental implants.

Dental implants are the ONLY option that is considered permanent AND preserve the bone. Dental implants are typically considered when the patient has finished growing (after age 18).

Treatment:

Final result 5 years after treatment:

 
 

Commentary:

  • As this patient experience illustrates, dental implants appear natural, aesthetic, and remain healthy well after 5 years.
  • We believe that if John maintains good dental hygiene and sees his dentist regularly, he can have these implant “teeth” for the rest of his life.
  • It is ultimately most important to us at Inland Institute that our patients have both aesthetic and long-term functional success.
  • We were so delighted John had such a remarkable experience with natural replacement of his missing front teeth.

Dr. Gilbert &  Team