CRCM  Vol.3 No.11 , November 2014
Mandibular Distraction Osteogenesis for the Treatment of an Obstructive Sleep Apnea Patient with Orthognathic Anomaly: A Case Report and Literature Review
ABSTRACT
Objective: skeletal advancement in order to improve the airway dimensions is known as one of the most effective surgical theraphy for treating obstructive sleep apnea (OSA). Distraction osteogenesis (DO) can be a better treatment alternative in some selected cases similar to our patient. Using custom made distractors can make this technique more safe and successful. Study Design: Surgically assisted rapid palatal expansion (SARPE), bilateral intraoral mandibular distraction osteogenesis (MDO) and orthodontic treatment were tried to a 20-year-old OSA patient with orthognathic anomaly. For mandibular distraction, custom made distractors were used. Results: The initial AHI of the patient was 23.3. At the end of the treatment it decreased to 8.7. Conclusions: Distraction osteogenesis could be a better alternative than the conventional orthognathic surgery in this kind of selected patients. Customization of the distraction devices can contribute to making this procedure safer and more successful.

Cite this paper
Şençimen, M. , Ayberk Altuğ, H. , Akçam, T. , Erdemci, F. , Bayar, G. , Altuğ, H. and Arıcı, G. (2014) Mandibular Distraction Osteogenesis for the Treatment of an Obstructive Sleep Apnea Patient with Orthognathic Anomaly: A Case Report and Literature Review. Case Reports in Clinical Medicine, 3, 621-630. doi: 10.4236/crcm.2014.311133.
References
[1]   Jones, R., Badlani, J. and Jones, C. (2010) Maxillary, Mandibular and Chin Advancement Surgery for the Treatment of Obstructive Sleep Apnoea. Australian Dental Journal, 55, 314-321.
http://dx.doi.org/10.1111/j.1834-7819.2010.01241.x

[2]   Holty, J.E.C. and Guilleminault, C. (2010) Maxillomandibular Advancement for the Treatment of Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis. Sleep Medicine Reviews, 14, 287-297.
http://dx.doi.org/10.1016/j.smrv.2009.11.003

[3]   Jacobson, R.L. and Schendel, S.A. (2012) Treating Obstructive Sleep Apnea: The Case for Surgery. American Journal of Orthodontics and Dentofacial Orthopedics, 142, 435-442.
http://dx.doi.org/10.1016/j.ajodo.2012.08.005

[4]   Alanko, O.M., Svedström-Oristo, A.L. and Tuomisto, M.T. (2010) Patients’ Perceptions of Orthognathic Treatment, Well-Being, and Psychological or Psychiatric status: A Systematic Review. Acta Odontologica Scandinavica, 68, 249-260.
http://dx.doi.org/10.3109/00016357.2010.494618

[5]   Oliveira De Felippe, N.L., Da Silveira, A.C., Viana, G., et al. (2008) Relationship between Rapid Maxillary Expansion and Nasal Cavity Size and Airway Resistance: Short- and Long-Term Effects. American Journal of Orthodontics and Dentofacial Orthopedics, 134, 370-382.
http://dx.doi.org/10.1016/j.ajodo.2006.10.034

[6]   Pirelli, P., Saponara, M., Guilleminault, C., et al. (2004) Rapid Maxillary Expansion in Children with Obstructive Sleep Apnea Syndrome. Sleep, 27, 761-766.

[7]   Marino, A., Ranieri, R., Chiarotti, F., et al. (2012) Rapid Maxillary Expansion in Children with Obstructive Sleep Apnoea Syndrome (OSAS). European Journal of Paediatric Dentistry, 13, 57-63.

[8]   Sher, A., Schechtman, K. and Piccirillo, J. (1996) The Efficacy of Surgical Modifications of the Upper Airway in Adults with Obstructive Sleep Apnea Syndrome. Sleep, 19, 156.

[9]   Sencimen, M., Bayar, G.R., Akçam, T., Altug, H.A., Altug, H., Gulses, A. and Ozkan, A. (2012) Management of Obstructive Sleep Apnea by Maxillomandibular Advancement Surgery in an Edentulous Patient. Journal of Craniofacial Surgery, 23, 582-583.
http://dx.doi.org/10.1097/SCS.0b013e31826befe0

[10]   Özgür, N. (2007) Uyku apne sendromlu ve saglikli bireylerin üst solunum yolu yapisal özelliklerinin arastirilmasi ve mandibular repositioner apareyi uygulamasinin bu degerler ile uyku apne sendromu üzerine etkisinin incelenmesi. Gazi üniversitesi Saglik Bilimleri Enstitüsü Protetik Dis Tedavisi Anabilim Dali Doktora Tezi, Ankara.

[11]   Codivilla, A. (1905) On the Means of Lengthening, in the Lower Limbs, the Muscles and Tissues Which Are Shortened Through Deformity. The Journal of Bone & Joint Surgery, 2.4, 353-369.

[12]   McCarthy, J.G., Schreiber, J., Karp, N., Thorne, C.H. and Grayson, B.H. (1992) Lengthening the Human Mandible by Gradual Distraction. Plastic & Reconstructive Surgery, 89, 1-8.
http://dx.doi.org/10.1097/00006534-199289010-00001

[13]   Cohen, S.R., Ross, D.A., Burstein, F. D., Jean-Francois, L., Frcsc, J. E. and Cathy, S. (1998) Skeletal Expansion Combined with Soft-Tissue Reduction in the Treatment of Obstructive Sleep Apnea in Children: Physiologic Results. Otolaryngology-Head and Neck Surgery, 119, 476-485.
http://dx.doi.org/10.1016/S0194-5998(98)70105-6

[14]   Williams, J.K., Maull, D., Grayson, B.H., Longaker, M.T. and McCarthy, J.G. (1999) Early Decannulation with Bilateral Mandibular Distraction for Tracheostomy-Dependent Patients. Plastic & Reconstructive Surgery, 103, 48-57.
http://dx.doi.org/10.1097/00006534-199901000-00009

[15]   Li, K.K., Riley, R.W., Powell, N.B., Trol, R.J. and Guilleminault, C. (1999) Overview of Phase II Surgery for Obstructive Sleep Apnea Syndrome. Ear, Nose, & Throat Journal, 78, 851, 854-857.

[16]   Nie, P., Zhu, M., Lu, X.F. and Fang, B. (2013) Bone-Anchored Maxillary Expansion and Bilateral Interoral Mandibular Distraction Osteogenesis in Adult with Severe Obstructive Sleep Apnea Syndrome. Journal of Craniofacial Surgery, 24, 949-952.
http://dx.doi.org/10.1097/SCS.0b013e318286883b

[17]   Conley, R.S. and Legan, H.L. (2006) Correction of Severe Obstructive Sleep Apnea with Bimaxillary Transverse Distraction Osteogenesis and Maxillomandibular Advancement. American Journal of Orthodontics and Dentofacial Orthopedics, 129, 283-292.
http://dx.doi.org/10.1016/j.ajodo.2005.11.029

[18]   Brevi, B.C., Toma, L., Magri, A.S. and Sesenna, E. (2011) Use of the Mandibular Distraction Technique to Treat Obstructive Sleep Apnea Syndrome. Journal of Oral and Maxillofacial Surgery, 69, 566-571.
http://dx.doi.org/10.1016/j.joms.2010.09.007

[19]   Master, D.L., Hanson, P.R. and Gosain, A.K. (2010) Complications of Mandibular Distraction Osteogenesis. Journal of Craniofacial Surgery, 21, 1565-1570.
http://dx.doi.org/10.1097/SCS.0b013e3181ecc6e5

[20]   Gassman, C.J., Van Sickels, J.E. and Thrash, W.J. (1990) Causes, Location, and Timing of Relapse Following Rigid Fixation after Mandibular Advancement. Journal of Oral and Maxillofacial Surgery, 48, 450-454.
http://dx.doi.org/10.1016/0278-2391(90)90229-U

[21]   Komori, E., Sagara, N. and Aigase, K. (1991) A Method for Evaluating Skeletal Relapsing Force during Maxillomandibular Fixation after Orthognathic Surgery: A Preliminary Report. American Journal of Orthodontics and Dentofacial Orthopedics, 100, 38-46.
http://dx.doi.org/10.1016/0889-5406(91)70047-Z

[22]   Beukes, J., Reyneke, J.P. and Becker, P.J. (2013) Medial Pterygoid Muscle and Stylomandibular Ligament: The Effects on Postoperative Stability. International Journal of Oral and Maxillofacial Surgery, 42, 43-48.
http://dx.doi.org/10.1016/j.ijom.2012.05.010

[23]   Carlson, D.S., Ellis III, E. and Dechow, P.C. (1987) Adaptation of the Suprahyoid Muscle Complex to Mandibular Advancement Surgery. American Journal of Orthodontics and Dentofacial Orthopedics, 92, 134-143.
http://dx.doi.org/10.1016/0889-5406(87)90368-4

[24]   Li, K.K., Powell, N.B., Riley, R.W. and Guilleminault, C. (2002) Distraction Osteogenesis in Adult Obstructive Sleep Apnea Surgery: A Preliminary Report. Journal of Oral and Maxillofacial Surgery, 60, 6-10.
http://dx.doi.org/10.1053/joms.2002.29049

 
 
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