Korean J Orthod.  2019 Jul;49(4):265-276. 10.4041/kjod.2019.49.4.265.

Maxillomandibular advancement surgery after long-term use of a mandibular advancement device in a post-adolescent patient with obstructive sleep apnea

Affiliations
  • 1Department of Orthodontics, Kyung Hee University Graduate School, Seoul, Korea.
  • 2Department of Orthodontics, Kyung Hee University School of Dentistry, Seoul, Korea. ksj113@khu.ac.kr
  • 3Department of Oral and Maxillofacial Surgery, Kyung Hee University School of Dentistry, Seoul, Korea.
  • 4Department of Otorhinolaryngology Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea.

Abstract

Patients with obstructive sleep apnea (OSA) whose phenotype belongs to a craniofacial vulnerability are referred from sleep doctors to orthodontists. In adults, for osseo-pharyngeal reconstruction (OPR) treatment, permanent maxillomandibular advancement (MMA) surgery and use of a temporary mandibular advancement device (MAD) are applied. This case report demonstrates successful treatment of OSA through application of phased MAD and MMA in a 16-year-old male with craniofacial deformity and residual growth potential. This patient showed skeletal and dentoalveolar changes after 7-year MAD use throughout post-adolescence, which affected the design and timing of subsequent MMA surgery, as well as post-surgical orthodontic strategy. This case report suggests that OPR treatment can be useful for treatment of OSA in post-adolescent patients, from an orthodontic point of view, in close collaboration with sleep doctors for interdisciplinary diagnosis and treatment.

Keyword

Obstructive sleep apnea; Maxillomandibular advancement surgery; Mandibular advancement device; Surgery-firtst approach

MeSH Terms

Adolescent
Adult
Congenital Abnormalities
Cooperative Behavior
Diagnosis
Humans
Male
Mandibular Advancement*
Orthodontists
Phenotype
Sleep Apnea, Obstructive*

Figure

  • Figure 1 Pretreatment facial and intraoral photographs.

  • Figure 2 Pretreatment dental casts.

  • Figure 3 Lateral cephalograms. A, Pretreatment. B, After 7 years of wearing the mandibular advancement device (MAD). C, Superimposition of A and B.

  • Figure 4 Facial and intraoral photographs after 7 years of mandibular advancement device use. Facial convexity was reduced, while the Class III molar and canine relationship with shallow overjet and overbite showed progression.

  • Figure 5 Dental casts after 7 years of mandibular advancement device use.

  • Figure 6 Computer-assisted three-dimensional (3D) planning of maxillomandibular advancement surgery with genioplasty using Simplant Pro software (Materialize Dental, Leuven, Belgium) (A), 3D printed intermediate wafer (B), and final wafer (C).A, Point A; ANS, anterior nasal spine; U1, upper central incisor; Pog, pogonion; Me, menton.

  • Figure 7 A, Lateral cephalograms taken at post-treatment. B, Superimposition of alignment after 7 years of wearing the mandibular advancement device (MAD) (7 yr-post-MAD) and post-treatment.

  • Figure 8 Post-treatment facial and intraoral photographs.

  • Figure 9 Post-treatment dental casts.

  • Figure 10 Facial and intraoral photographs at 1.5 years post-retention.

  • Figure 11 Comparative cone-beam computed tomography images of the craniofacial and pharyngeal airway in three dimensions at pretreatment (A–E) and 1.5 years post-retention (F–J).


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