Sleep apnea treated with orthognathic surgery

What is orthognathic surgery?

Orthognathic surgery or surgery of the facial skeleton is a set of techniques that serve to mobilize the various bony elements that make up the face, jaw, maxilla, chin, cheekbones, and place them in the ideal situation.

Who needs orthognathic surgery?

Orthognathic surgery is indicated, on the one hand, for those patients who have an alteration of the skeletal elements that make up the face that cause an aesthetic deformity, therefore most of our patients who seek orthognathic surgery do so for aesthetic reasons. There is also another part of patients in which the main problem is an alteration in the occlusion of the teeth, when the jaw or maxilla are poorly positioned teeth do not fit well and the first reason for consultation or what bothers the patient is that the teeth do not fit. They come to us and then we propose a joint treatment in which an orthodontist is responsible for arranging the teeth and then we take care of moving the bones and put them in place. It is considered that a large number of the population could eventually benefit from orthognathic surgery because they have some kind of alteration, by excess or defect, in the size and shape of the bones of the face.

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Is orthognathic surgery a definitive solution for sleep apnea?

Sleep apnea is a problem that affects women and men, it is a major problem, and basically consists in the fact that patients who suffer from it have an airway through which they breathe that collapses at night when they are lying down and then the air does not pass. It is a severe problem that, in the most aggressive forms, leads to hypertension, cardiovascular problems and even death. These patients need to be connected for life, at night, to a mask that supplies them with oxygen at high pressure and keeps the airways open. There is an important percentage of these patients in which the cause of this airway collapse is an alteration in the position of the maxilla and/or mandible, fundamentally the mandible. In these cases, orthognathic surgery, by repositioning the maxilla and mandible forward, manages to widen and increase the volume of the airway and allow the airflow to normalize. Patients suffering from sleep apnea who undergo orthognathic surgery are completely cured and disconnected from the famous Cpap machine, which they call the infernal machine.

What advances have been made in orthognathic surgery?

The most important advances in orthognathic surgery are, on the one hand, in diagnosis and planning. At the Maxillofacial Institute we have developed a virtual, three-dimensional planning platform that allows us to use a scan of the patient’s face to plan three-dimensionally or to reproduce three-dimensionally the surgery that we will later perform on the patient. This gives us a level of precision of tenths of a millimeter that also makes the surgery much shorter and therefore the recovery much greater. The research of this platform and its validation, which we have developed during the last 3 years, will be published shortly in the international journal of oral and maxillofacial surgery. The other major breakthrough is the development of minimally invasive surgery techniques. We are now able, through small incisions in the gum, made inside the mouth, to reach the bones and by making small cuts in the bones, mobilize them and place them in the position we have previously designed with three-dimensional planning. These surgeries, which classically lasted 4 or 5 hours, now last between half an hour and an hour and a half and this allows the patient to go home the next day.

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What type of anesthesia will be used and what is the recovery time for the surgery?

Classically orthognathic surgery is performed under general anesthesia and even today in cases in which we have to mobilize the maxilla and mandible, the so-called bimaxillary surgery, it is still performed under general anesthesia. However, years ago we started a protocol by virtue of which the cases in which we only have to operate on the mandible are performed or can be performed under local anesthesia and sedation. They are very short surgeries that last around 30 minutes and the patient arrives, is operated on an outpatient basis and a short time after the surgery he/she can go home. This obviously has a very favorable impact on the patient’s recovery and also on the patient’s perception of the intensity of the surgery.