Introduction: Obstructive sleep apnea syndrome (OSAS) is a sleep-related breathing disorder. The objective of this paper is to present a clinical case with OSAS successfully treated through orthognathic surgery.
Keywords: Sleep apnea, obstructive, upper airway, orthognathic surgery, surgery first, osteotomy, Le Fort, osteotomy, sagittal split ramus
Material and Methods: Male patient, 43 years and 3 months old, with moderate OSAS and an apnea-hypopnea index of 22. In the cephalometric analysis, a skeletal Class I (< ANB 3º) with a setback in the position of the maxilla (< SNA 77º) and mandible (< SNB 74º) in relation to the skull base was observed. This skeletal pattern favors the narrowing or obstruction of the upper airway, which was confirmed by the radiographic examination. The proposed treatment plan consisted of: orthognathic surgery, using the Surgery First technique, with Le Fort I maxillary advancement of 7 mm and impaction of 2 mm and bilateral sagittal osteotomy with mandibular advancement of 7 mm.
Results: Two months after surgery, there were no post-surgical complications, the patient reported an improvement in symptoms associated with OSAS, and in the assessment of radiographic examinations was observed an increase in the volume and the minimum axial dimension of the upper airway.
Discussion: The bimaxillary advancement surgery allows the anterior pharyngeal wall to move forward, resulting in the enlargement of the pharyngeal airway and, consequently, a decrease in the apnea-hypopnea index.
Conclusions: The Surgery First technique allowed for immediate surgery and the consequent improvement of OSAS. Bimaxillary advancement movement increased the volume and minimum axial distance of the upper airway.