Orthodontic and Surgical Management of Obstructive Sleep Apnea

Obstructive Sleep Apnea Syndrome (OSAS) is associated with increased morbidity and mortality; although the etiologic factor responsible for OSAS has not been clearly elicited, it is well recognized that disproportionate anatomy of the upper airway exists in OSAS, leading to obstruction during sleep. Although continuous positive airway pressure therapy is one of the most common forms of treatment for OSAS, surgery has always played an integral part in its treatment.

Diagnosis:

A lateral cephalometric x-ray is one of the most commonly used diagnostic tools in measuring posterior airway space. A fiberoptic nasopharyngeal laryngoscopy is highly recommended. This exam enables the clinician to directly visualize the entire upper airway from the nose to the larynx. A three dimensional CAT scan has also recently been used.

Treatment:

One of the most recent treatments of OSAS has been pre-operative orthodontic treatment followed by a maxillomandibular and genioglossous advancement procedure. Recently I have been recommending that our patients have four bicuspid extractions in order to retract the upper and lower anterior teeth to decompensate before the bi-maxillary advancement. This pre-operative orthodontic treatment can maximize the advancement and minimize the soft tissue lip protrusion which is usually observed after surgery. Our patients who have had the pre-operative orthodontic treatment followed by maxillomandibular and genioglossous advancement have shown 95-100% positive results with their sleep test.