Surgical orthognathic management of sleep apnea.

Management of obstructive sleep apnea syndrome (OSAS) requires a clear understanding of both the medical and surgical components of the treatment and interpretation of the subjective and objective data such as the polysomnagram. Medical management is primarily by continuous positive airway pressure (CPAP) and is the first line of treatment. Surgical management consists of several phases based on the severity and location of the anatomical abnormalities. The last phase of surgical management consists of maxillo-mandibular advancement by a Le Fort I osteotomy and bilateral sagittal split ramus osteotomies of the mandible. The orthognathic procedure is based on the existing skeletal deformity, occlusion and severity of the OSAS. The surgical technique must also take into consideration not only the usual orthognathic principles but the added medical complexity of these patients in the immediate pre and post operative periods.