Otolaryngologie : accès libre

Abstrait

Treatment of Obstructive Sleep Apnea Syndrome through Orthodontics and Orthognathic Surgery: A Case Report with a Five Year Follow-Up

Omar Shafic Ayub,Bruno Ayub*,Priscila Vaz Ayub,Dirceu Barnabé Ravelli,Paulo Domingos Ribeiro,Margareth da Silva Coutinho

Introduction: Obstructive sleep apnea (OSA) results from the presence of abnormal soft and hard tissues in the upper airway, which cause the collapse of the oropharynx in the deeper stages of sleep. Different treatment modalities have been proposed for OSA, aiming to offer a better quality of life for the patients. Orthognathic surgery via maxillary-mandibular advancement (MMA) decreases the collapse of soft and hard tissue structures during sleep and has a high success rate. The facial and occlusal improvement, the enhancement on respiratory function and the less morbid postoperative period are some advantages responsible for the growing acceptance of this technique. Case report: This case reports a combination of orthodontic treatment and orthognathic surgery via MMA in a 51 year old man with OSA. The initial polysomnography showed an apnea-hypopnea index of 49.2 and arousal index of 21.7. Follow-up polysomnography performed 15 months after surgery revealed significant improvement. The apneahypopnea index decreased to 2.9 and the arousal index to 12.3. The patient reported significant improvements in life quality, sleep quality, and nasal breathing capacity, as well as a decrease in daytime sleepiness and snoring. Thus far, the patient has been under postoperative follow-up for 5 years and 6 months, without any complaints of breathing difficulties during the day or night. Conclusion: The combination of orthodontic and surgical treatment via MMA may be a favorable alternative treatment for improving the respiratory symptoms of patients with OSA and is highly indicated for patients with maxillary-mandibular discrepancies.