악교정수술에 의한 폐쇄성 수면 무호흡증 환자의 치험례

MAXILLARY, MANDIBULAR, AND GENIAL ADVANCEMENT FOR TREATMENT OF OBSTRUCTIVE SLEEP APNEA : A CASE REPORT

Obstructive sleep apnea syndrome (OSAS) is characterized by repeated collapse of the upper airway, producing hypopnea, apnea, and ultimately, oxygen desaturation of hemoglobin. The major characteristics of OSAS are male predominance, obesity, hypersomnolence, and excessive snoring. Patients suffer deterioration of memory and judgement, irritability, morning headache, sexual dysfunction, and personality changes. Psychologic changes involving the cardiopulmonary system occur and may lead to life-threatening events. The presurgical evaluation includes nocturnal polysomnography, clinical examination, radiologic evaluation, and fiberoptic endoscopy. The current surgical procedures used for OSAS are tracheostomy, tonsillectomy, adenoidectomy, nasal surgery (septoplasty, partial turbinectomy), tongue reduction, uvulopalatopharyngoplasty (UPPP), anterior sagittal osteotomy of the mandible with hyoid myotomy and suspension, and maxillary, mandibular and hyoid advancement. Selection of the surgical procedure is based upon the severity of the sleep apnea, presence of a skeletal deficiency, presence of morbid obesity, and anatomic site of the obstructive process. Patient with OSAS documented by polysomnography, was evaluated by cephalometric analysis, and polysomnography before and 6 months following the surgical procedure. Patient underwent maxillary, mandibular osteotomies via Lefort I, SSRO, and genioplasty.