Abstract
Background: Maxillomandibular advancement (MMA) is a safe and highly effective treatment for obstructive sleep apnoea (OSA). MMA is one type of orthognathic surgery planned to maximise the forward movement of the maxillomandibular complex (MMC) and expand pharyngeal airway in OSA patients. Therefore, MMA may cause excessive maxillomandibular protrusion, especially on patients with thinner facial soft tissue. Objective: To prevent unfavourable facial aesthetics after MMA while maintaining the maximal advancement of MMC, the authors perform segmental maxillomandibular rotational advancement (SMMRA) as the modification technique of the MMA. Methods: SMMRA is combination with Le Fort I osteotomy, maxillary anterior segmental osteotomy to provide additive advancement of posterior maxilla using extracted premolar space and bilateral sagittal split osteotomy. MMC is undergoing counterclockwise rotation. Findings and Conclusions: A 33-year-old male patient suffered from sleep disorder was referred to our hospital. He had body mass index of 23 kg/m2 and mandibular retrognathism. Cephalometric X-ray showed mandibular retrusion and narrow pharyngeal airway. Polysomnography (PSG) indicated moderate OSA (apnoea–hypopnoea index [AHI] = 23/h; lowest SaO2 = 80%). SMMRA combination with trapezoid mortised genioplasty was performed. Postoperative cephalometric X-ray showed that ANB improved 13–3°. Pogonion was advanced by 20 mm. Middle and lower pharyngeal airway increased by 8 mm and 10 mm, respectively. Postoperative PSG indicated drastic improvements (AHI = 1.7/h; lowest SaO2 = 89%). Six-year follow-up will be presented. The patient's sleep condition, occlusion and aesthetic were stable 6 years after SMMRA. However further follow-up and management is recommended.
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