Obstructive sleep apnea (OSA) occurs as an increased collapsibility of the upper airway during sleep, which threatens health and quality of life. Asian men with greater severity of OSA presents less obese and are connected with craniofacial abnormalities. Although the traditional maxillomandibular advancement (MMA) had the comparable effectiveness to the continuous positive airway pressure therapy, the midfacial esthetics might be compromised in Asian individuals. The modified MMA procedure was proposed to balance the esthetic demands and improvement of OSA symptoms. The case report showed a 25-year-old man presented with a diagnosis of severe OSA. The pretreatment Apnea Hypopnea Index (AHI) score was 100 events/h. He exhibited skeletal Class II hyperdivergent facial pattern with mandibular retrognathism. To correct dentofacial deformities and improve sleep function, the modified surgical-orthodontic procedure was undertaken. The surgery-first approach was adopted for early improvement of OSA. The surgical procedures of SMMRA comprise the maxillary LeFort I segmental osteotomy, bilateral sagittal split osteotomy and genioglossus-genioplasty osteotomy. The counterclockwise rotation of maxillomandibular complex was further done to maximize mandibular advancement. The total treatment duration was 13 months. The well-aligned dentitions and solid dental occlusion were achieved. The subjective perception of sleep quality was improved. The patient was satisfied with the post-treatment facial appearance. Following the skeletal movement, the dimension of pharyngeal airway space was increased. The post-treatment AHI score was reduced to 12.1 events/h; the nadir oxygen saturation increased from 74% to 86%. The case report demonstrated the SMMRA procedure effectively improved adult Asian patients with severe OSA without deterioration of facial attractiveness and dental occlusion.
Hung, Hsien-Ching; Teng, Ya-Ying; Hsieh, Yuh-Jia; Wang, Yi-Chin; and Wang, Yu-Chih
"Segmental Maxillomandibular Rotational Advancement (SMMRA) in the Treatment of Adult Patients with Severe Obstructive Sleep Apnea,"
Taiwanese Journal of Orthodontics: Vol. 33:
3, Article 6.
Available at: https://www.tjo.org.tw/tjo/vol33/iss3/6
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