Maxillomandibular advancement to cure sleep apnea syndrome

27 December 2010

I introduce you to Émile, 48 years old. Émile is suffering from severe sleep apnea. He had from 45 to 48 respiratory stops (pauses) per hour. He has been looking for a solution for his sleep apnea problem for almost 10 years already. He underwent an uvuloplasty (removal of the uvula of the soft palate) and an amygdalectomy at the same time. He says that he suffered very much and it did not solve his sleep apnea problem at all. He tried wearing a mandibular advancement device that worked at first, but his teeth started to move due to the traction put on his teeth by the appliance at night. He put the device away. A Continuous Positive Airway Pressure (CPAP) machine was recommended to him. He has been using it for a few years and it works well, except that he does not see himself having to sleep with such a device beside him for his whole life. He is starting to suffer from nasal mucus membrane dryness because of the pulsed air. His several medical consultations led him to oral surgery and orthodontics.

Here is his testimony 10 days after undergoing a maxillofacial surgery that consisted of:

•A Le Fort I osteotomy for maxillary advancement of 9 mm and impaction of 2 mm.

•A bone graft to the malar bones (cheekbones) with bone from the iliac crest (pelvis).

•A bilateral sagittal split osteotomy for mandibular advancement of 13 mm.

•A genioplasty for symphysis advancement of 8 mm and the modification of the genioglossus muscles.

Here is what Émile had to say on 27 December, 10 days after his surgery:

“My pulmonologist, who practices at the Hôpital Laval in Quebec City, diagnosed me with sleep apnea. I had to procure a CPAP machine to sleep. Suffering from insomnia, I had a lot of problems adapting to this device, so I consulted a pulmonologist again.

The pulmonologist Dr Bruno Rabi introduced me to Dr Dany Morais, maxillofacial surgeon at the Hôpital de l’Enfant-Jésus in June 2009. Dr Morais noticed my jaw malformation problem and agreed to operate on me, but only after receiving an orthodontic treatment to correct the angle of my teeth. I thus chose Dr Sylvain Chamberland for my orthodontic treatment.

One year after I started my orthodontic treatment, I underwent my maxillofacial intervention successfully on 17 December 2010 at the Hôpital de l’Enfant-Jésus. My nose is still a little bit stuffy, but I am feeling well. I no longer sleep with my CPAP machine. I can drink a glass of water without choking. I breathe. What a blessing!

I thank my orthodontist for his professional work.”