title: Maxillomandibular advancement surgery as alternative to continuous positive airway pressure in morbidly severe obstructive sleep apnea: a case report.
abstract: Obstructive sleep apnea syndrome (OSAS) is a sleep-related breathing disorder, characterized by disrupted snoring and repetitive upper airway obstructions. Oral appliance therapy is an effective alternative to continuous positive airway pressure (CPAP) and is especially effective in mild and moderate OSAS cases. Successful oral appliance therapy has been suggested as a predictor for successful maxillomandibular advancement (MMA) surgery in OSAS patients. MMA surgery has gained increasing popularity in this field since this procedure is associated with an enlargement of the entire velo-oro-hypopharyngeal airway. The authors present an unusual case of a CPAP-intolerant morbidly obese female (body mass index (BMI) = 40) with morbidly severe OSAS (apnea-hypopnea index (AHI) = 139, lowest oxyhemoglobin saturation level = 73%), who underwent a successful combination of MMA surgery, a modified genioplasty and cervicomental liposuction after oral appliance therapy. The post-surgical AHI was 6, and the lowest oxyhemoglobin saturation level increased to 86%. The authors suggest that this surgical combination should be seriously considered in obese patients with severe OSAS and CPAP intolerance.
authors.affiliation: Dept. of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands. m.h.j.doff@umcg.nl
authors.forename: Michiel H J
authors.initials: MH
authors.lastname: Doff
authors.forename: Johan
authors.initials: J
authors.lastname: Jansma
authors.forename: Rutger H
authors.initials: RH
authors.lastname: Schepers
authors.forename: Aarnoud
authors.initials: A
authors.lastname: Hoekema
mesh_terms: D000328:Adult; D045422:Continuous Positive Airway Pressure; D005260:Female; D063172:Genioplasty; D006801:Humans; D015187:Lipectomy; D019186:Mandibular Advancement; D008437:Maxilla / Q000601:surgery*; D009767:Obesity, Morbid / Q000150:complications*; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000601:surgery*