Airway and Skeletal Surgery

A multidisciplinary team is crucial to properly manage patients with obstructive sleep apnea (OSA). Orthognathic surgery is considered a curative treatment, since it increases upper airway volume and reduces the apnea–hypopnea index. Current guidelines indicate orthognathic surgery for moderate and severe OSA, although patients suffering from mild OSA also benefit from surgery. Patient-tailored orthognathic surgery should be carried out (instead of classical standard 10 mm maxillomandibular advancement), considering both the facial and airway morphology of the patient and taking into account that maxillomandibular advancement with counterclockwise rotation affords more predictable airway expansive outcomes. Mandibular advancement devices are reserved for non-obese patients with mild-to-moderate OSA refractory to, or non-compliant with, continuous positive airway pressure, and for patients who are not candidates for surgery due to health reasons, and also as a prognostic element in eventual orthognathic surgery.