[Combined surgical and prosthetic therapy of severe obstructive sleep apnea--a case report].

We report on a 41-year old patient who complained of loud snoring, excessive daytime sleepiness and chronic nasal obstruction. Clinical findings were septal deviation and enlarged turbinates, tonsillar hypertrophy with velar webbing and pharyngeal narrowing. Polysomnography revealed severe obstructive sleep apnoea syndrome with an apnoea-hypopnoea index (AHI) of 51.7/h. As the patient refused nCPAP therapy, we performed septoplasty with conchotomy and an uvulopalatopharyngoplasty with tonsillectomy. Snoring and excessive daytime sleepiness disappeared completely and the AHI decreased to 31.1/h. The mandibular advancement device Snorban was subsequently fitted. We found a complete resolution of OSAS. The AHI was 4.4/h. The postsurgical polysomnographic results were stable two years after surgery. However, the patient discontinued using the oral device as he did not feel any additional benefit when using it. The combination of UPPP and mandibular advancement device can resolve a severe OSAS.