An orthodontic–orthognathic conceptual approach to OSAS surgery: our experience and results

Abstract

Introduction It is well recognised that obstructive sleep apnea syndrome is linked with upper airway obstruction during sleep. The psychomotor sequelae of OSAS, including excessive daytime sleepiness, cefalea, daytime fatigue, increased cardiovascular morbidity and mortality and poor sleep quality with performance impairment due to sleep fragmentation, are also well described. In 1983 Powell and coauthors described the first mandibular advancement (MMA) to treat OSAS and subsequently they advocated simultaneous maxillary and mandibular advancement in an attempt to improve results. Materials and methods Nowadays, the surgical techniques, borrowed from orthognathic surgery are used with great success in surgical OSAS treatment. Long-term success with MMA is valuable in 90–100% of cases. This surgical approach has been shown repeatedly to be a highly effective treatment modality for OSAS in patients with maxillo-mandibular deficiency, but also in OSAS patients without maxillo-mandibular deficiency with equally successful outcomes. The aesthetic appearance of a patient, who exhibits normal craniofacial skeletal morphology, will get worse after surgical procedure leading to a biprotrusion profile. When planning the surgery, the surgeon has to consider the aesthetic deterioration degree in order to obtain the maximum enlargement of the upper airway whilst maintaining an acceptable aesthetic. Concerning the efforts to minimize the aesthetic impairment, pre-surgical orthodontic treatment and, subsequent, orthognathic surgery may improve the aesthetic and functional treatment results. Results The authors describe their approach to OSAS presenting a 10 patients series composed of very different kinds of maxillo-mandibular conditions related to OSAS. We reached a 100% success for AHI Conclusion MMA as described in the literature concerned with the forward reposition of maxillo-mandibular complex preserving the personal dental occlusion.Using the CPAP support during presurgical orthodontic preparation we can spend some time to normalize dental arches form and compensation in order to obtain at surgery the best skeletal position and dental occlusion. Even the eumorphic patients can take advantage of presurgical orthodontic treatment, the orthodontist may plan the best occlusion according to the MMA. It entails a more stable dental occlusion which itself fights against the deterioration tendency of the surgical result. Pre-surgical orthodontic treatment qualifies as orthognathic surgery even in OSAS patients.