Counterclockwise Rotation of the Maxillomandibular Complex for the Correction of Dentofacial Deformities and Sleep Apnea

2021 ◽  
pp. 415-435
Author(s):  
Larry Wolford
Keyword(s):  
Sleep Apnea ◽  
Counterclockwise Rotation ◽  
Dentofacial Deformities

scholarly journals Prevalence and risk factors of silent obstructive sleep apnea in patients with dentofacial deformities

2021 ◽  
Author(s):  
Rei Jokaji ◽  
Kazuhiro Ooi ◽  
Sayuri Takamichi ◽  
Yusuke Nakade ◽  
Shuichi Kawashiri ◽  
...  
Keyword(s):  
Risk Factors ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Rem Sleep ◽  
Orthognathic Surgery ◽  
Sleep Phase ◽  
Deep Bite ◽  
Mandibular Asymmetry ◽  
Dentofacial Deformities ◽  
Obstructive Sleep

Abstract Objective Prevalence of silent obstructive sleep apnea (OSA) in patients with dentofacial deformities is unknown, although OSA is severe risk of airway obstruction in perioperative orthognathic surgery or complication after surgery. The aim of this study was to investigate prevalence and risk factors of silent OSA in patients with dentofacial deformities. Methods We analyzed 72 patients (24 male, 48 female) with dentofacial deformities without previous OSA symptoms. Polysomnography was performed before orthognathic surgery. Prevalence and risk factors of silent OSA were statistically analyzed as related to Apnea hypopnea index (AHI). Results Mean AHI was 1.6 (range: 0-12.1) /h. Three patients of 72 patients (4.1%) were diagnosed silent OSA. AHI during REM sleep phase 3.7 (0-32.3) was higher than AHI during NREM sleep phase 1.0 (0-9.7). AHI of male patients was higher than that of female. AHI was increased according to high BMI. AHI was higher in deep bite than open bite, edge to edge bite and nomal bite. AHI of mandibular asymmetry cases were higher than that of symmetry cases. Conclusions The prevalence of silent OSA was 4.1%. Obesity, male, deep bite, mandibular asymmetry and REM sleep phase were risk factors of silent OSA.

Orthognathic Surgery

2019 ◽  
Author(s):  
Howard D Wang ◽  
Robin Yang ◽  
Joseph Lopez ◽  
Edward W Swanson ◽  
Amy Quan ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Orthognathic Surgery ◽  
Surgical Planning ◽  
Upper Airway ◽  
Successful Outcome ◽  
Le Fort ◽  
Sagittal Split Osteotomy ◽  
Dentofacial Deformities ◽  
Dentofacial Deformity ◽  
Le Fort I

Orthognathic surgery describes the surgical movement of the mandible and maxilla to correct dentofacial deformities that result from congenital or traumatic etiologies. Patients with dentofacial deformity often have malocclusion and functional problems related to breathing, chewing, or speech articulation. Furthermore, facial asymmetries or disproportions resulting from dentofacial deformities can adversely affect the psychosocial health of the patient. The goal of orthognathic surgery is to improve both function and form beyond what can be achieved with orthodontic or medical treatments. Some of the most commonly performed orthognathic surgery procedures include Le Fort I osteotomy of the maxilla, bilateral sagittal split osteotomy of the mandible, and genioplasty. Successful outcome after orthognathic surgery should be judged by achieving an improved dental occlusion, enhanced facial aesthetics, and open upper airway. A number of studies have shown that orthognathic surgery leads to significant improvements in the quality of life of patients with dentofacial deformities. Orthognathic surgery also has a significant impact on the upper airway. In patients with severe obstructive sleep apnea, maxillomandibular advancement has the potential to lead to dramatic improvements in the apnea-hypopnea index and lowest oxygen saturation value. With careful surgical planning and execution, consistent outcomes can be expected.   This review contains 17 figures, 4 tables, and 32 references. Key Words: aesthetic surgery, dentofacial deformity, genioplasty, Le Fort I, malocclusion, orthognathic surgery, sagittal split osteotomy of the mandible, sleep apnea, virtual surgical planning

scholarly journals Surgery-First Maxillomandibular Advancement for Obstructive Sleep Apnea with Post-Operative Sequential Clear Aligner Orthodontic Treatment

2021 ◽  
Author(s):  
Ho-Hyun (Brian) Sun
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Orthodontic Treatment ◽  
Treatment Protocol ◽  
Orthodontic Appliances ◽  
Intermaxillary Fixation ◽  
Maxillomandibular Advancement ◽  
Dentofacial Deformities ◽  
Obstructive Sleep ◽  
Removable Orthodontic Appliances

Maxillomandibular advancement (MMA) is a surgical intervention that reduces the symptoms of obstructive sleep apnea via anterior repositioning of the upper and lower jaws. Pre-operative orthodontic alignment is often a critical component in aiding MMA. Orthodontia are important in intraoperative anchorage for intermaxillary fixation, healthy post-operative occlusion, and post-operative skeletal stability. Sequential clear aligners (SCA) refer to removable orthodontic appliances that are replaced at regular intervals to stimulate dental migration without the use of bonded hardware. These aligners have demonstrated efficacy in aiding orthognathic surgery for dentofacial deformities, which share some technical similarities with MMA for OSA. Here, we explore the treatment protocol for MMA followed by post-operative SCA treatment. Our experiences show that post-operative orthodontic treatment with SCAs results in similarly successful post-operative surgical outcomes given that the patient’s pre-operative occlusion is stable.

Treating Velopharyngeal Inadequacy Using Bilateral Buccal Flap Revision Palatoplasty

2019 ◽  
Vol 4 (5) ◽  
pp. 878-892
Author(s):  
Joseph A. Napoli ◽  
Linda D. Vallino
Keyword(s):  
Systematic Review ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
A Priori ◽  
Sufficient Evidence ◽  
Obstructive Sleep ◽  
Before And After ◽  
Buccal Flap

Purpose The 2 most commonly used operations to treat velopharyngeal inadequacy (VPI) are superiorly based pharyngeal flap and sphincter pharyngoplasty, both of which may result in hyponasal speech and airway obstruction. The purpose of this article is to (a) describe the bilateral buccal flap revision palatoplasty (BBFRP) as an alternative technique to manage VPI while minimizing these risks and (b) conduct a systematic review of the evidence of BBFRP on speech and other clinical outcomes. A report comparing the speech of a child with hypernasality before and after BBFRP is presented. Method A review of databases was conducted for studies of buccal flaps to treat VPI. Using the principles of a systematic review, the articles were read, and data were abstracted for study characteristics that were developed a priori. With respect to the case report, speech and instrumental data from a child with repaired cleft lip and palate and hypernasal speech were collected and analyzed before and after surgery. Results Eight articles were included in the analysis. The results were positive, and the evidence is in favor of BBFRP in improving velopharyngeal function, while minimizing the risk of hyponasal speech and obstructive sleep apnea. Before surgery, the child's speech was characterized by moderate hypernasality, and after surgery, it was judged to be within normal limits. Conclusion Based on clinical experience and results from the systematic review, there is sufficient evidence that the buccal flap is effective in improving resonance and minimizing obstructive sleep apnea. We recommend BBFRP as another approach in selected patients to manage VPI. Supplemental Material https://doi.org/10.23641/asha.9919352

Sign in / Sign up

Export Citation Format

Share Document