Virtual Surgical Planning for Osseous Surgery to Manage Obstructive Sleep Apnea

The use of maxillofacial osteotomies for the treatment of dentofacial deformities has a long and storied history. Movement of the maxilla, mandible, and chin can be performed in all three planes of space in order to achieve the appropriate skeletal changes. Historically, surgeons anecdotally noted improvement in patient-reported signs and symptoms of daytime somnolence, snoring, and nighttime observations of apneic episodes by bed partners in a subset of their orthognathic surgical patients. As such, it becomes clear over time that osseous advancement of the facial bones could provide relief of airway obstruction. The use of maxillofacial osteotomies to manage the patient with PAP-intolerant obstructive sleep apnea has been validated both as a rescue treatment for patients failing other types of OSA procedures (such as UPPP) and as a primary treatment. Such treatments advance the osseous insertion points of soft tissues that support airway patency. Specifically, anterior movement of the maxilla advances the soft palate, superior aspect of the pterygomandibular raphe, and associated connections to the superior pharyngeal constrictor while also permitting intra-nasal modifications such as septoplasty, removal of bone spurs, osseous recontouring, and turbinoplasty. Advancement of the mandible and chin directly advances the attachments of the genioglossus, geniohyoid, mylohyoid, digastric muscles, and the inferior aspect of the pterygomandibular raphe.