Use of the mandibular distraction technique to treat obstructive sleep apnea syndrome.

Severe cases of obstructive sleep apnea syndrome (OSAS) are treated with surgical techniques borrowed from orthognathic surgery. The most commonly used method is maxillomandibular advancement (MMA), which has shown a high success rate. [1] and [2] Several studies have failed, however, to find a direct link between the amount of advancement and the posterior airway space (PAS) obtained. Although these 2 factors seem to vary proportionately, no statistical correlation has been demonstrated.3 The best option therefore is to advance the maxillomandibular complex as much as possible (without considering cephalometric parameters) to achieve an acceptable esthetic result and restore proper occlusion. [4] and [5] The primary goal in treating patients with OSAS is to create the largest possible retrolingual space by advancing the mandible (and, hence, the maxilla to maintain the occlusal relation). This process minimizes the tendency of the airways to collapse. Some cases allow a large advancement without esthetic problems. We present a few such cases in which the orthognathic technique of mandibular osteodistraction was used to achieve 1- to 2-cm advancements. This procedure allows the surgeon to monitor mandibular displacement during the distraction and thereby obtain the intended protrusion without creating an esthetically unacceptable shape. It also avoids damage to the inferior alveolar nerve and permits adaptation of the mandibular condyles when necessary. McCarthy et al6 first used distraction osteogenesis (DO) to lengthen the mandibles of pediatric patients with hemifacial microsomia. The subsequent introduction of intraoral devices significantly improved mandibular osteodistraction techniques due to the inconspicuous nature of the devices and the absence of facial scarring. [7], [8] and [9] DO has recently become the preferred treatment for the management of growing patients with mandibular hypoplasia and respiratory problems. [10] and [11] Its use in adult patients is more controversial; although several investigators have suggested that the distraction method should replace classic techniques, [12] and [13] most surgeons do not accept this proposed course of action. The surgical procedure proposed in this article to treat severe OSAS cases thus represents a technical innovation