Clinic Announcement | Fenghua United Clinic: Adjustments to Clinic Outpatient Clinics on Election Day

This is a patient with extreme sleepiness. His Epworth Sleepiness Scale score is 17. If the score is over 10, it is considered to have reached the level of sleepiness that requires medical intervention. The sleep report he brought from the hospital showed that his AHI was as high as 64.5 (AHI>30 is severe sleep apnea) and his lowest blood oxygen level reached 60%. For patients with retruded mandible and severe sleep apnea, orthognathic surgery (Maxillo-Mandibular Advancement, MMA) should be one of the priority treatment options, especially since this patient is completely unable to accept having to wear a positive pressure ventilator for a long time. The CT scan after the operation showed that the narrow and blocked airway had been widened and supported through the reorganization of the upper and lower jaws. At the same time, the face shape, jaw line, tooth angle and bite state also benefited from the orthognathic surgery. Most importantly, the postoperative sleep report showed that the AHI had dropped to 4.3, which is the same as the normal standard, and the minimum blood oxygen level had increased to 83%. Subjectively, in addition to greatly reducing snoring, he felt much more energetic during the day and was not sleepy.

Let me share the case of a 39-year-old male patient. Due to insufficient development of the upper and lower jaw bones, they were compressed backwards, resulting in airway stenosis, sleep apnea (AHI 22.5), and daytime sleepiness. The patient's airway space was successfully improved through orthognathic surgery on both jaws, nasal septum correction and lower nose clip plasty surgery. Three months after the operation, the AHI dropped to 5.1, the lowest blood oxygen concentration increased to 93%, and the patient's mental state and quality of life were significantly improved.

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…

A patient with severe sleep apnea (AHI=69.8) decided to seek treatment because of severe snoring that affected his family's quality of life, especially after the birth of his child, and daytime sleepiness. After trying non-surgical methods such as side sleeping, positive pressure respirators, and anti-snoring braces with limited results, I finally chose to undergo MMA orthognathic surgery. After the operation, the AHI dropped from 69.8 to 13, and the minimum blood oxygen concentration during sleep increased from 53% to 83%. This not only improved the mental and physical strength, but also made the family no longer need to wear earplugs to sleep.

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.

Effectively treat sleep apnea through airway lift and jaw surgery! In this case, the patient's initial treatment with a positive pressure respirator was not effective and affected his quality of life. After counterclockwise rotation of the upper and lower jaw, combined with chin osteotomy, it not only improves the airway compression problem, but also balances the side lines of the face. Sleep breathing testing showed that the AHI index dropped significantly from 50.1 to 13.4, and the snoring situation was significantly improved, bringing patients better sleep quality.