North Texas Dentistry Volume 9 Issue 6 2019 ISSUE 6 DE | Page 14

SMILES
SPOTLIGHT
in the
EVALUATION & TREATMENT
A 27-year-old female presented to our office with concerns about her
mandibular retrognathia, class II malocclusion, and untreated severe sleep
apnea (AHI 48) due to failed CPAP use. In conjunction with Dr. Terry Adams
and his team, we developed a plan to improve her sleep apnea, correct her
malocclusion, and create facial harmony with maxillomandibular advancement
surgery.
LEADERS IN NORTH TEXAS DENTISTRY
CREATING UNFORGETTABLE SMILES
Orthognathic surgery to address
severe sleep apnea: Without a
compromise of facial esthetics
Randy R. Sanovich, DDS
DALLAS SURGICAL ARTS
An estimated 22 million Americans suffer from lack of restorative sleep.
Typical symptoms of sleep apnea include heavy snoring, excessive day-
time sleepiness, and difficulty with concentration or memory. Untreated
sleep apnea can lead to serious health consequences, but with treat-
ment many people see dramatic improvements to their quality of life.
Failure of conservative therapy in patients with severe sleep apnea
(AHI > 30) is disappointingly common, with 20-40% rejecting treatment
with CPAP, and up to 30% failing treatment with a mandibular advance-
ment splint. For these patients, finding an acceptable treatment can be
challenging. Surgery may appear to be an attractive option to the patient,
as it may be perceived as an instant solution to their disease that does
not involve wearing awkward or restricting medical devices.
Jaw surgery (also called “orthognathic surgery”) for sleep apnea can
consist of a variety of surgical designs. The most successful orthog-
nathic surgery type for severe obstructive sleep apnea is maxillo-
mandibular advancement surgery (MMA), which averages around a
90% reduction in AHI post-operatively. The surgery involves creating an
osteotomy in the upper and lower jaws and the chin, and advancing the
jaws anteriorly. This movement not only opens the airway in the
anterior-posterior dimension, but also expands the airway laterally which
is key for preventing collapse of the airway in patients with severe
disease. Patients with pre-op mandibular retrognathia tend to have an
anatomic cause for sleep apnea, and have the most esthetically pleasing
result and greatest airway expansion with maxillomandibular advance-
ment surgery.
14 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
She initially underwent 5 months of pre-surgical orthodontics where her
maxillary and mandibular arch were aligned and leveled. Space was made
between the maxillary lateral incisor and canine roots and she was ortho-
dontically positioned to undergo a multi-piece Le Fort I Osteotomy, sagittal
split osteotomy, and functional advancement genioplasty with inclusion of