Objective: To discuss the indication and protocol of surgical therapy when treating mandibular micrognathism accompanying obstructive sleep apnea-hypopnea syndrome (OSAHS) using distraction osteogenesis and orthognathic surgery.
Methods: A total of 17 patients with mandibular micrognathism accompanying moderate to severe OSAHS, aged 11 to 59 years, 15 men and 2 women, were reviewed. Four of them were treated with orthognathic surgery, 5 of them were treated with distraction osteogenesis, and the other 8 patients were treated with an integrated procedure combining distraction osteogenesis with orthognathic surgery. Cephalometric analysis and polysomnography studies were obtained pre- and postoperatively.
Results: SNB angle changed from 64.6 degrees to 71.9 degrees, post airway space (PAS) from 5.4mm to 13.2 mm, apnea and hypopnea index (AHI) from 58.4 to 7.6, lowest saturation of oxygen (LSAT) from 66% to 87%. All the differences showed statistical significance (P < 0.001). The average mental horizontal advancement (MHA) was 14.3 mm and its correlation coefficients with deltaSNB, deltaPAS, deltaAHI, and deltaLSAT were 0.36, 0.62, 0.34, and -0.14, respectively.
Conclusions: Both distraction osteogenesis and orthognathic surgery can be effectively used to treat patients with mandibular micrognathism accompanying OSAHS with slightly different indications. A combination of these two operations may be preferred.