Dr Paul Coceancig
Obstructive Sleep Apnea is a sleep disorder where your teen’s breathing is partially or completely blocked repeatedly during sleep.
This condition is due to narrowing or blockage of the upper airway during sleep and the repeated stoppages in breathing can last anywhere from a few seconds to a number of minutes.
The size of a teen’s jaw is often the primary cause of snoring and sleep apnea – which is why it is important to understand that any form of non-surgical treatment can do very little to improve breathing – and surprisingly, may potentially make some problems worse.
Orthodontic treatment alone in a teenager with small jaws is capable of improving the alignment of their teeth but won’t address the long-term effects of snoring and sleep apnea.
Visit Australian Society of Orthodontics and Australasian Sleep Association for more information.
Snoring and OSA are caused by a collapsed tongue which blocks the airway during sleep and are associated with small jaws.
This tongue collapse occurs when a state of deep sleep is reached and the body and tongue loses muscle tone, with the collapsed tongue falling back and obstructing the airway.
There are other factors that can contribute to snoring and OSA, most commonly excess weight or obesity, but can also include allergies or chronic upper airway infections.
The strained intake of air that occurs with snoring can also cause inflammation of the tonsils or adenoids, leading them to swell and further exacerbate airway obstruction.
Visit ASOHNS for further information.
The developing brain of a teenager needs between 8 and 10 hours of quality sleep every night.
The effects of chronic (ongoing) sleep deprivation due to impaired breathing, snoring or Obstructive Sleep Apnea may include:
Jaw surgery treats the cause of snoring and OSA, not just the many serious conditions they may cause.
There are many options available to teenagers with snoring issues. We believe the most effective treatment is to correct the central cause of sleep apnea.
If your teenage child has crowded teeth, a bad bite, obvious facial disproportion, and has breathing issues, you should be considering jaw correction as your primary solution – not your last.
In teenagers, the best approach is often through IMDO™ surgery which increases the size and volume of the jaws. This permanently opens the airway to enable normal and healthy breathing.
This leads to normal sleeping patterns, superior exercise tolerance, improved mental and emotional wellness, and better overall health both now and as your teenager progresses through to adulthood.
Snoring and sleep apnea are caused by a collapsed tongue blocking the airway during sleep, and is usually associated with small jaws.
This tongue collapse occurs when you enter a state of deep sleep and your body and tongue loses muscle tone, with the collapsed tongue falling back and obstructing the airway.
This airway obstruction prevents normal breathing and continuously wakes you during the night, often without you realising. These continuous disruptions are what lead to poor quality sleep.
The complete stoppages in breathing can last from seconds to minutes, and can occur over thirty times an hour to well over hundreds of times every night.
There are other factors that can contribute to snoring and sleep apnea, the most common of which are excess weight or obesity, but can also include allergies or chronic upper airway infection.
But any or all of these only increase your sleep apnea, with the primary cause almost always being small jaws that produce the tongue collapse that causes airway obstruction.
Snoring and sleep apnea can lead to many serious medical conditions if left untreated.
These serious medical conditions may include a person being:
The most common health issues are heart disease, Type 2 diabetes, obesity and high blood pressure. Extreme drowsiness throughout the day is common which makes you less alert and prone to injury.
Experiencing breathing difficulties through the day, particularly after exercising, indicates you likely experience some degree of airway obstruction, which only becomes more profound during sleep.
The best treatment for snoring and sleep apnea is a permanent one.
There are a variety of different treatments that can improve the symptoms of OSA and alleviate the risk of associated illnesses, including CPAP, MAS and soft tissue ENT surgeries.
However, the most effective way of permanently curing OSA is by correcting the primary cause of sleep apnea, which is almost always small jaw and facial structures.
BiMax surgery permanently opens your airway to enable normal breathing when awake and during sleep, eliminating the tongue collapse that produces airway obstruction.
Jaw surgery is a scientifically proven and a research-backed means of correcting sleep apnea, with hundreds of successfully treated patients now experiencing a life free of sleep apnea.
The effectiveness of CPAP therapy is measured by the AHI score through repeat sleep studies. An AHI score is the number of times you stop breathing for periods of longer than 10 seconds during sleep.
The goal of CPAP is to reduce the AHI score by reducing the average number of apnea episodes experienced by a person per hour while they are sleeping
However, CPAP does NOT reverse hypertension, diabetes, obesity, heart disease, or stroke risk. And, more importantly, CPAP does not cure a person of OSA.
CPAP will never give anyone a permanent AHI of 0 because a sleep study does not acknowledge or eliminate the reasons why OSA is happening in the first place.
IMDO™ is a revolutionary jaw surgery solution to fix a small lower jaw and big overbite. Along with simultaneously correcting a small upper jaw – In teenagers.
IMDO™ surgery involves growing the lower jaw in just under two weeks – to the exact size required to enable normal breathing, eliminate snoring, and maximise the chance of an optimal bite.
Adding LeFort surgery to the IMDO™ procedure (using custom titanium) dramatically improves nasal airway and nasal breathing – and corrects the proper 3D position of the upper jaw and the relationship to the rest of the face. Combining LeFort and IMDO™ surgery gives a powerful overall facial, airway and smile balance.
Bringing the upper jaw forward helps us to grow the lower jaw forward to its maximum achievable potential. This overcomes obstructive sleep apnea, and corrects the dental bite too.
Unlike BSSO – IMDO™ can be used in growing adolescents – dramatically shortening orthodontic times, and saving crowded and impacted teeth from being extracted.
We want your child to keep all of the facial furniture nature intended – including 32 adult teeth, tonsils, adenoids and sinuses; we just want to make the living room bigger by growing the small jaw.
To do this it’s like growing an ice cube. We’re simulating natural growth. We are growing your jaw and face to the normal size that nature had always intended.
The impact that IMDO™ treatment has on teens is about far more than the aesthetics, though self esteem and confidence do receive a boost with jaw surgery.
Treating a growing face with IMDO™ usually avoids the need to remove teeth and minimises orthodontic treatment times.
The enhancement in breathing dramatically improves their quality of sleep meaning that their ability to concentrate at school and perform academically generally increases.
Being able to breathe more easily also increases their exercise tolerance and can help instill a love of physical activity that can carry into adulthood.
LeFort Surgery for a Gummy Smile changes the height of your upper jaw. Lifting your jaw upwards allows us to normalise your tooth and gum display, and establish your ideal facial proportions.
LeFort Jaw Surgery advances your upper jaw to a position that complements your lower jaw.
It normalises your bite, opening up your airway to improve breathing and encourage better sleep patterns, and establishing ideal facial proportion.
BiMax is a surgical procedure where both jaws are significantly advanced using custom-engineered titanium plates together with GenioPaully to augment the chin. Both jaws are brought forward using LeFort for the upper and BSSO for the lower jaw.
SARME jaw widening surgery is a highly effective procedure that widens your upper jaw to improve breathing and make room for complete dental alignment without needing to remove teeth.
We generally suggest LeFort 1 for gummy smile surgery. It changes the height of the upper jaw and normalises the tooth and gum display, which allows more ideal facial proportions. It can also improve the air flow behind the soft palate which leads to improved breathing and better sleep patterns as it diminishes the effects of snoring and Sleep Apnoea.
We suggest LeFort surgery for underbites, to normalise the bite, open up the airways and establish ideal facial proportions. LeFort moves the upper jaw into a position that complements the lower jaw, balancing how the teeth meet when chewing, biting and smiling, minimising the potential for tooth wear and jaw joint pain.
Braces and aligners deal with the positioning of the teeth, so if your jaw formation is being hindered by the position of the teeth, retainers and braces can assist with fixing one component of an effective treatment pathway. However, alone, they can not change the structure of your jaws and face.
No. While they might contribute to crowding of the teeth, an underbite is a combination of genetic and developmental discrepancies of the jaw, and is not correlated with wisdom teeth.
A common misconception – and sometimes misrepresentation – is that having prominent front teeth (an overbite or large overjet) is a feature of having BIG front teeth or having too many upper teeth; leading to dental extractions (of premolars) and retraction (pull back) orthodontics.
Invisalign and braces are VERY good at repositioning the front teeth backwards. However, combined with dental extractions often over many teenage years, the effect of holding teeth in growing jaws can have the effect of shrinking and distorting the upper jaw – with the orthodontic aim to make it match and correlate with the set-back lower jaw (and set-back lower dental arch).
Overall – the effect can give the impression of a corrected dental overbite and a straight smile. But there is often a reduced number of natural teeth, and very often a bigger sense of adult facial imbalance – alongside the emergence of adult breathing problems.
The adult based surgery required to correct the overall facial disharmony – which means expanding the originally small lower jaw, and to restore the original upper jaw position, structurally – can only be gained through corrective jaw surgery, which is called a remedial BIMAX .
There are many people who believe that overbites and crowded teeth are caused by soft diets. This has led to a belief that hardening the diet will naturally correct the dental crowding and bite problems associated with small jaws.
Growing jaws by increasing the density of your diet is not a view upheld by medical science. Or our experience of seeing it first hand.
Although overbites can become less or more severe with age – as teeth wear or become naturally lost – an overbite, dental crowding and dental impactions will not spontaneously correct themselves through random teenage growth or in adulthood.
Only surgical therapies that deliberately increase the volume of the jaws – will correct for the alignment and normal occlusion of 32 natural teeth.
Facial asymmetry can become more pronounced with age, so it’s important to treat asymmetry as early as possible so that aging asymmetry is minimal and natural, and compounded due to existing asymmetry.
Our practice is very digitally driven. Most patients see us via Zoom or GoogleMeet, and enjoy the ease of speaking to us from their home or office.
Our staff will liaise with radiology and dental offices in your home town – to help coordinate the complex digital data we need to help make digital diagnosis and digital-based surgery possible. We work with engineers in Belgium, Switzerland, Ukraine, Colombia and Malaysia, and our appliances are imported into Australia with full local TGA and local service support.
Our coordination is such that we only meet most patients for the first time in hospital – and just prior to their surgery. Locally we liaise with our dental clinic partners, nurses and doctors to help with your post surgery rehabilitation – and all before we send you back home.
Once you are home, we will liaise with your local dentists or doctor to maintain your care there – and which we will try to monitor using reviews through either Zoom and Google Meet. All you need is a webcam, and access to your own town clinics and services. Let us do the rest.
Working with your dentist, GP, psychologist, sleep specialist or orthodontist is key to your overall health. Have them write your referral for you, or we can help obtain the necessary people to assist you.
If you are finding it hard to explain your condition to a professional, friend or family member – we recommend you buy the book 6 Ways To Design Your Face.
In Australia, you are advised to visit your GP who will assess your symptoms and provide you with a medical referral. Ensure you allow your GP to understand your overall condition before seeking jaw corrective surgery.
It is advised to speak to as many medical specialists as possible, and gain multiple treatment or diagnostic opinions before embarking on any form of irreversible treatments.
Jaw surgery aligns your jaws to their ideal position within the architecture of your face. The ultimate aim of jaw surgery is to enhance your chewing, speaking and breathing. The improvements to your facial profile and appearance are an added benefit of treatment.
At its core, corrective jaw surgery is a functional medical procedure. It is not performed for the deliberate enhancement of facial aesthetics, and is not to be considered a “cosmetic” surgery procedure.
Jaw surgery is designed to open up the airway behind the tongue, in order to relieve airway obstruction and improve breathing. This can ultimately relieve a person’s snoring, sleep-disordered breathing, and their risk of developing sleep apnea.
Another aim of treatment is to create space for teeth to uncrowd naturally, or with the assistance of gentle orthodontic treatments. The newly established bite at the end of treatment helps balance your chewing and eliminate current or future jaw joint problems.
There are many different types of jaw surgery, and the ones you may benefit from are unique to you. We can present your available treatment options using detailed 3D imagery of your jaw and facial structures.
For clients based in Australia, we will coordinate doctors, dentists, radiologists, and medical doctors to help you get the treatment you need. We will also help you coordinate travel, accommodation and timetables to make your visit to our hospitals as smooth as possible. We have a large Australian network of dentists clinics, Computed Tomography (CT) clinics and orthodontic providers who send patients to us for surgery, and where diagnostic and coordinated clinical treatments can be predictably practiced.
For overseas clients, all of our consulting and diagnostic processes are digital. We regularly share our protocols with radiologist houses to enable you to receive the best scanning possible. If you want to visit us here, then many expatriate professionals working in the financial, mining, diplomatic and accounting services industries often have international medical policies that can offer comprehensive coverage. If you are self funded, we have extraordinary relationships with our custom titanium manufacturers & hospitals to offer reasonable prostheses and medical costs management.
If you want help navigating the complexity of medical insurance, we can also help by providing information.
Step 1. We need to meet you first. Give us your details and we will send you a chapter of your choice from our book “6Ways To Design A Face”… Book a consultation online. Consultations can be conducted face to face in our Surry Hills office or over ZOOM. Please bring your referral from your medical GP. Your referral will also assist with Medicare rebates. Medicare offers many benefits to Australians for specialist surgical services such as ours.
Step 2. If you feel Dr Paul is right for you, we will offer the opportunity for a virtual diagnostic and digital-operation process called an O&O. This step allows us to diagnose you and determine exactly what it is you surgically need to move forward with treating your individual problems. We will help coordinate our surgical treatments with your GP or Orthodontist or dental doctor. We will also tell you exactly what surgery you will need, and advise you on what insurance level you will also need and the timelines we expect will occur over your treatment course. It’s only after step 2 that we can really know what is wrong with you, and how we can fix you, and how we can predict the cost of that.
Step 3. Surgery. This is where a managed team plan is performed. When the surgery is over we will pass you onto your dentist or orthodontist or medical doctor to continue your special journey.
Maxillofacial Surgeons are trained to handle a wide variety of conditions that people were born with or developed. These conditions affect the jaw, smile, airway and face and ultimately your health.
We understand no one person is the same, nor is there a one-size-fits-all surgery for all jaw and facial concerns.
We offer solutions for a wide range of conditions. We see each patient as an individual and design a personalised solution that ensures you the best outcome for your needs.
If you would like a second opinion on what is the right jaw surgery solution for you, contact The Australian & New Zealand Association of Oral & Maxillofacial Surgeons.
By making the decision to see Dr Paul Coceancig you are taking an important step in finding a permanent solution to your jaw-related problems.
Dr Paul is a highly-respected professional and pioneer in his field who is passionate about improving the lives of his patients.
Prior to any surgical treatment, Dr Paul will explain the risks associated with the procedure as well as provide written information on the procedure as well as pre and post-operative care.
Always seek a second opinion and never rush into any elective treatment that may be offered to you. If you want a second surgical opinion, you can access:
Also ask for the brochure on “Orthognathic Surgery” by ANZAOMS, and purchase the book “6Ways To Design A Face.”
We offer customised solutions for a wide range of jaw and facial conditions. Before making any recommendations we undertake an individual patient assessment to design a personalised solution that ensures you achieve the best outcome for your needs. We can provide more information on treatment options and costs at an individual consultation.
In Australia, Medicare works with your hospital (medical) insurer to make private surgery in a hospital – affordable, predictable and accessible. Speak to your surgeon to find out more – or if you are already a patient of ours, call our patient clinical coordinator for advice.
Regional Australian and country patients benefit from proximity to our airports (both Sydney International and Newcastle), interstate train (XPT) and road network centrality. We will help you apply for regional travel/accommodation subsidies from your local hospital network, and we offer ZOOM routinely (consultation, CT diagnostic and review).
Newcastle is specifically attractive to most interstate and regional visitors, being that the Hunter region has excellent budget accommodation, hotels, beaches and lifestyle destinations (particularly the Hunter wine region).
For overseas patients, international health insurance can offer significant benefits and coverage. Australia offers some of the finest private hospital and operative-nursing care in the world, and NSW offers amazing hotel and regional stay options. We are experienced providers to many overseas patients, and we offer experience of treating people from many specific countries.
If you are self funded, we can talk to you about the additional costs of hospitals, anesthetists, prostheses and surgeon costs that form the overall surgical costs of care. We can also liaise with your orthodontist or doctor overseas to help with radiology, prostheses engineering, online diagnostics, and home-based orthodontic or dental care.
Dr Paul and his team of highly trained specialists will work closely with you to ensure you receive the very best professional support and care during every step of your journey with us.
From your first consultation to your surgery and post-operative care we look after your every need. Your health is our priority.
This website provides general advice only. Always consult with your GP first to discuss your medical history and symptoms and always gain a second specialist opinion. Every person is different, and specialist assessments are key to understanding the risks associated with any treatment and whether a particular treatment is right – or not right – for you.
Monday – Friday (8am – 5pm)
Ground Floor, 33 Albion Street
Surry Hills NSW 2010