Abstract

RUBIO-BUENO, Pilar et al. Obstructive sleep apnoea: an innovative minimally invasive approach using mandibular branch distraction. Rev Esp Cirug Oral y Maxilofac [online]. 2018, vol.40, n.2, pp.55-64. ISSN 2173-9161.  https://dx.doi.org/10.1016/j.maxilo.2017.04.001.

An innovative and minimally invasive approach for adult obstructive sleep apnoea by using bilateral internal ramus distraction osteogenesis of the mandible is presented. After a careful virtual 3 D planning, mandibular distraction surgery is performed under general anaesthesia and endoscopic assistance, using a major ambulatory surgery protocol, with the patient being discharged home the same day. After an initial latency of 5 days, the ascending ramus is gradually lengthened vertically during a period varying between 10 and 50 days, at a rate of 0.5 mm to 1 mm daily, until an apnoea-hypopnoea index below 5/h is achieved (cure level), and/or a negative overjet > 10 mm is reached.

Titration of the procedure according to clinical criteria with the assistance of polygraphy and/or polysomnography allows the clinician to customise the mandibular advancement to each particular case. After a mandibular ramus lengthening ranging between 10 and 25 mm, the distraction devices are kept in place for 6 months after completion of the consolidation period.

Bilateral internal ramus distraction is a highly effective surgical technique in curing obstructive sleep apnoea in adults with or without retrognathia, and could be indicated even in patients with comorbidities, such as cardiovascular disease or morbid obesity, in which a major surgical procedure, i.e. conventional maxillomandibular advancement, should be discouraged.

Keywords : Obstructive sleep apnoea; Sleep-disordered breathing; Orthognathic surgery; Respiratory obstruction; Mandibular distraction osteogenesis; Minimally invasive surgery; Maxillomandibular advancement.

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