OSAS Treatment with Mandibular Osteotomy Modified Associated with Virtually Planned Orthognathic Surgery

Abstract

Obstructive sleep apnea (OSA) is a common sleep disorder classically characterized by apneic events that lead to intermittent hypoxia and sleep fragmentation. Its consequences are serious, mainly in terms of quality of life and cardiovascular risk. Orthognathic surgery of the maxillomandibular advancement has increased in popularity as a treatment option for OSAS due to the increase in the entire velo-oro-hypopharyngeal air system. A modified osteotomy is indicated for patients with severe obstructive sleep apnea who already have a prominent profile. In these cases, it is necessary to advance the suprahyoid muscles without changing the facial profile. The genioglossus is crucial to maintaining a pharyngeal patent in the air due to the anterior traction of the tongue. The advancement of the genioglossus muscle has been reported as an option for the surgical treatment of obstructive sleep apnea syndrome, which through its traction can increase the retrolingual airway without altering facial or dental appearance. The present study aims to report a clinical case of a female patient (N.M.A.T.), 52 years old, presenting complaints of lack of concentration and fatigue on light effort, OSAS confirmed by polysomnography and snoring. On facial tomography, retrognathism and reduction of the upper airways were observed. Orthognathic surgery with counterclockwise rotation of the maxillary-mandibular complex, associated mandibular and maxillary advancement was the treatment of choice, associated with the advancement of the genioglossus muscle through modified osteotomy in the anterior portion of the mandible. The virtual planning was carried out for the case, with the preparation of pre and transoperative guides and with the purpose of visualizing the growth of the airways. The patient improved his facial profile and airways due to anterior muscle traction, evolving without complaints.