Surgical-Orthodontic Treatment of Skeletal Class II Malocclusion with Obstructive Sleep Apnea and Multiple Missing Teeth

Abstract

In the treatment of skeletal Class II retrognathic mandible, the airway should be considered for the progress and outcome of the treatment. The case report demonstrates combined orthodontic and orthognathic surgery in a 39-year-old woman with chief complaint of maxillary protrusion. The clinical examination and X-ray revealed skeletal Class II with a retrognathic mandible, high mandibular plane, vertical maxillary excess (VME), bilateral deformed condyles, and narrow posterior airway space. Moreover, the patient had several missing teeth with a posterior lingual crossbite. Polysomnography revealed obstructive sleep apnea (OSA), with a high apnea–hypopnea index (AHI) of 12.1/h. Her body mass index was low at 17.2. The preoperative orthodontic treatment included leveling, alignment, and molar uprighting. Maxillary segmental LeFort I was designed to expand her maxillary intermolar width and impact the anterior part of her maxilla. Also, bilateral sagittal split osteotomies were performed to advance her mandible position with a counterclockwise rotation of the maxillomandibular complex. The postoperative orthodontic treatment included settling the bite, monitoring the relapse, and managing the dental space for future prosthodontic rehabilitation. After a total treatment time of 1 year and 10 months, her profile was improved, her airway volume was enlarged, and her OSA was resolved, with the AHI changed to 4.3/h at 11 months after surgery then further decreased to 0/h when debonded.