Orthognathic Surgery and TMJ Prosthesis to Treat an OSAS Patient Without Ascending Ramus and TMJ Since Childhood: A Case Report

Introduction Obstructive sleep apnoea syndrome (OSAS) is a common primary sleep disorder with repetitive partial or complete upper airway collapse during sleep. Continuous positive airway pressure (CPAP) is the gold standard treatment for adults with OSA, however long-term CPAP adherence can be very low. Surgical treatment can be an effective option, especially in presence of maxillofacial anatomical deformities. Case Summary We present the case of a 29-year-old man with severe OSAS, no right mandibular ramus, and a deformity of the right mandibular body. The surgical procedure included positioning of a patient-specific total temporomandibular joint (TMJ) prosthesis and associated maxillomandibular advancement (MMA). Discussion We achieved an apnoea decrease > 90% (AHI to 5.2/hour of sleep). Moreover, the aesthetics and chewing improved dramatically. Even if longer follow-up is needed to assess the postoperative stability of the bone position and sleep apnoea reduction, simultaneous MMA and TMJ reconstruction allowed us to obtain excellent results.