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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.

Why might a receding chin cause breathing difficulties while sleeping? This article takes you inside the operating room, from pre- and post-operative images and 3D digital surgical planning to CT scans, to understand the relationship between a receding chin and airway narrowing, and how MMA orthognathic surgery increases airway space by moving the jawbone forward.

Discuss the case of sleep apnea treatment in a female patient with long chin. Unlike other patients with mandibular retrusion, her airway obstruction point was located in the retropalatal space and nasal cavity. It was diagnosed that it was caused by maxillary retrusion and stenosis. Through clockwise rotation of both jaws, orthognathic surgery moves the upper jaw forward and simultaneously reduces the thickness of the inferior turbinate, successfully improving respiratory problems. This case shows that sleep apnea has multiple causes and requires accurate diagnosis and customized treatment plans.

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 patient with moderate to severe sleep apnea suffers from severe drowsiness during the day and difficulty staying awake at work due to narrowing of the airway due to retraction of the mandible. After orthognathic surgery to move the mandibular forward, not only did the AHI index drop from moderate to severe to 3.7, the respiratory tract was also significantly improved, the quality of sleep was improved, and the overall mental state was completely renewed. The surgery also improved the appearance of the retracted chin and allowed the patient to regain a healthy quality of life. It was a successful sleep apnea treatment case.