Case sharing
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.
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.
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 young man was troubled by severe obstructive sleep apnea (OSA), with an AHI index as high as 55.8, and symptoms such as loud snoring, daytime sleepiness, headaches, and difficulty concentrating. Because he was unwilling to use a positive-pressure respirator, he underwent mandibular advancement surgery (MMA) combined with chin advancement surgery to successfully expand the airway space. The AHI dropped to 3.9 6 months after the operation, and his symptoms were significantly improved. This case demonstrates the therapeutic effect of MMA surgery on patients with severe OSA, providing patients with a treatment option that does not require respirators.
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 sleep apnea patient had to sleep in a separate room with his girlfriend due to severe snoring. After undergoing 3D customized orthognathic surgery and chin advancement surgery, I was most happy when I returned for a follow-up visit six months after the operation. The happiest thing was that my snoring had improved, my girlfriend no longer complained, and I could finally sleep in separate rooms. This case not only improved the patient's sleep quality, but also restored the couple's relationship, demonstrating the importance of sleep apnea treatment in improving the quality of life.
This case shares the treatment experience of a patient with moderate sleep apnea (AHI 22.9). The patient had sleep problems due to mandibular and chin retraction, and was unable to adapt to CPAP treatment. Through 3D customized orthognathic surgery, using the treatment method of counterclockwise rotation and forward movement of the upper and lower jaw bones (CCW-MMA), the 6-month follow-up showed that the AHI dropped to 2.7, successfully improving the symptoms of sleep apnea, while improving the Appearance, the patient was quite satisfied with the surgical results.
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.
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.
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.
