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This patient had undergone orthodontic treatment with tooth extraction before, but later she found that the problems and concerns she had far exceeded whether her teeth were straight. This time she was referred to our center by a sleep specialist dentist, mainly to solve her severe daytime sleepiness and snoring problems during sleep. After a sleep test, she was diagnosed with moderate sleep apnea (AHI=19.4). CT also showed that her airway stenosis was caused by severe retraction of the mandible, which compressed the posterior airway space. Taking into account her obvious symptoms of sleep apnea (sleepiness, snoring), the cause (narrow bones, lack of space), and her expectations for appearance and occlusion, we designed an orthognathic surgery (MMA: maxillo-mandibular advancement) for her, which would widen her airway and improve her appearance and occlusion. Postoperative orthodontic treatment was performed by the referring physician using Invisilign. The sleep test result six months after the operation was AHI=1.4, which has returned to normal. The symptoms of snoring and sleepiness have disappeared, and she also likes the way she looks after the operation more.

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 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 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.

Discuss the treatment case of a patient with severe sleep apnea. The patient's AHI index is as high as 84.5, and he has a typical face with a receding mandible. After airway lifting treatment through orthognathic surgery, the AHI index was significantly reduced to 5.6, and the minimum blood oxygen concentration was increased from 50% to 90%. The surgery not only effectively improves the airway space, but also makes the patient's jaw proportions more harmonious. The case details the surgical plan, postoperative changes and recovery progress, providing treatment reference for patients with similar problems.

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.