Correction of severe obstructive sleep apnea with bimaxillary transverse distraction osteogenesis and maxillomandibular advancement

Obstructive sleep apnea (OSA) can be a debilitating, even life-threatening, condition. The most favorable treatment for patients with OSA is multidisciplinary care by a team that represents various dental and medical disciplines. Prescribed therapies might include weight loss, behavior modification, oral appliances, soft tissue surgery, skeletal surgery, or some combination of approaches. When orthognathic surgery has been used, often only the anteroposterior dimension is addressed, and the transverse dimension is overlooked. The treatment presented here demonstrates the important role that transverse expansion of the maxillary and mandibular arches can have for patients with severe OSA. An initial stage of maxillary and mandibular transverse distraction osteogenesis was performed, followed immediately by fixed orthodontic treatment. After appropriate orthodontic alignment, leveling, and coordination, a second surgical stage consisting of maxillary and mandibular advancement was performed. Marked enhancements in occlusion and facial morphology, and a profound improvement in the OSA, were obtained.