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Orthognathic surgery was originally designed to improve the bite and appearance of the patient. However, in the field of treating obstructive sleep apnea, orthognathic surgery (maxillo-mandibular advancement/MMA) has become a means to tighten the collapsed (relaxed) muscles rather than an end. Improvement in appearance and bite has become an added value of maxillo-mandibular advancement.

Orthognathic surgery was originally designed to improve the bite and appearance of the patient. However, in the field of treating obstructive sleep apnea, orthognathic surgery (maxillo-mandibular advancement/MMA) has become a means to tighten the collapsed (relaxed) muscles rather than an end. Improvement in appearance and bite has become an added value of maxillo-mandibular advancement.

A very sleepy patient came to see a doctor with a sleep report. The report showed that he had severe sleep apnea (AHI = 31.4 /hr). Due to the long-term lack of rapid eye movement (REM) sleep, he also developed clinical symptoms such as bad mood, memory deterioration and cognitive dysfunction. Over the years, he has tried positive pressure respirators and anti-snoring mouthpieces, but in recent years he has found it increasingly difficult to adapt to them. He would remove these breathing aids himself during sleep, which naturally had no therapeutic effect, so he hoped to seek more radical surgical treatment. We performed Maxillo-Mandibular Advancement (MMA) to widen his airway. From the CT scan, we can see the location of the obstruction (the suspensory part and the tongue root), which was well opened and widened. The position of the hyoid bone was obviously lifted upward and forward. The postoperative sleep report showed that the sleep apnea index (AHI) dropped from 31.4/hr to 7.5/hr, the minimum blood oxygen concentration increased from 80% to 89%, and the sleep structure was closer to that of healthy individuals. In principle, the treatment goal should be to reduce light sleep N2 and increase deep sleep N3 and the proportion of rapid eye movement (REM). Light sleep N2 dropped from 72.4% to 55.7% (N2 of a healthy individual should account for 55%), deep sleep N3 increased from 9.4% to 12.1% (N3 of a healthy individual should account for 15%), and most importantly, rapid eye movement (REM) increased from 9.4% to 24.8% (REM of a healthy individual should account for 25%). Because of the increase in deep sleep, the patient felt more well-rested and recharged after the operation, his mood was more positive, and he had more energy in life and work.

A 26-year-old male with an AHI of only 7.9 suffered from severe snoring, daytime sleepiness, and lethargy. 3D CT scans revealed a receding jaw, short face, and narrow airway. Through a combination of invisible braces and MMA maxillofacial repositioning surgery, airway space, deep bite, occlusion, and lower facial proportions were simultaneously improved. This case demonstrates that mild sleep apnea cannot be diagnosed solely based on AHI.

This 50-year-old woman suffered from severe sleep apnea (AHI = 40.5), with symptoms including severe daytime sleepiness (ESS = 17) and annoying snoring. Interestingly, a CT scan revealed that, in addition to the expected narrowing of her airways, she had undergone a Wassmund and Kole procedure in her youth. This procedure involves extracting one premolar from each side of her upper and lower jaws, then repositioning the upper and lower jaws through bone cutting to correct a protruding mouth.

This patient, suffering from severe sleep apnea and persistent snoring and daytime sleepiness, was found to have a receding jaw and airway narrowing upon examination. This article documents the changes in his CT scans, airway space, and sleep monitoring before and after orthognathic surgery…