Use of CAD-CAM technology to improve orthognathic surgery outcomes in patients with severe obstructive sleep apnoea syndrome

Introduction: Although multilevel surgery is the mainstay treatment for severe obstructive sleep apnoea syndrome (OSAS), bi-maxillary surgery (maxillomandibular advancement [MMA]) is the most efficacious single procedure for the expansion of the whole pharyngeal airway. MMA is an alternative to the gold standard of continuous positive airway pressure and is equivalent to tracheotomy. Patients and method: Computer-aided design/computer-aided manufacturing (CAD-CAM) technology was used to virtually assess the degree of mandibular and/or maxillary advancement and rotation required to obtain adequate posterior airway space (PAS) in eight patients (seven males, one female). The mean age of the patients was 45.5 years (range, 27-51 years), and the average body mass index was 28.9 kg/m(2) (range, 21.9-31.8 kg/m(2)). Results: The study group showed significant mandibular advancement, widening of the PAS, and reduction of the apnoea hypopnea index (p < 0.0001, p < 0.0001, and p < 0.0002, respectively). Moreover, patient satisfaction scores regarding postoperative facial profile changes showed excellent compliance. Conclusion: This study demonstrated that bi-maxillary surgery is an efficient single surgical procedure in patients with multilevel OSAS. CAD-CAM technology aided surgeons in performing this operation precisely and enabled patients to expect specific facial profiles. (C) 2019 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.