Sleep Apnea Treatment
Maxillomandibular Expansion
Patients who suffer from obstructive sleep apnea may have a condition known as narrowing of the upper and lower jaws. This narrowing of the jaws cause constriction of the intraoral volume specially the tongue and displace it towards the back of the throat consequently causing airway obstruction. To alleviate this, the upper and lower jaws can be expanded in order to improve the airway. Since orthodontic treatment is required with maxillomandibular expansion, it is typically performed on children and young adults (although there is no set age limit).
The surgery is performed by strategically positioned cuts in the jaws to allow gradual movement over time. This movement is achieved by placing a orthodontic device at the time of the surgery on the upper and lower jaws which acts as a distractor. A distractor is a device which incrementally over short period of time expands the jaws. The expansion length depends on the amount of space required and could be as long as two to three weeks on average. Since the jaws have been expanded, after the period of distraction, there would be a gap between the teeth. This space is closed orthodontically over a period of about three to six months depending on the space created. The orthodontic expanders are usually removed three months after the expansion has been completed.
The studies have shown that an increase in the transverse dimensions of the jaws by maxillary expansion and mandibular distraction osteogenesis dramatically decreased the obstructive sleep apnea (OSA) index.
This operation is performed under general anesthesia in a hospital setting which on average is about three hours. Patients usually are hospitalized an average of one to three nights. Recovery is about two to four weeks at which time patients may return to work.
Complications with this surgery are the same for most surgeries which includes; bleeding, infection, numbness of the lips (usually transient), swelling and damage to dentition of which all are minimal.
Since there is a transverse change in the jaw position there would be a minimal change in facial appearance which is usually esthetically pleasing. There would be no changes in swallowing, speech or function.
Rapid maxillary distraction can be achieved by orthodontics in young children with midline cartilaginous tissue. Distraction creates more space for the tongue so as to prevent its collapse posteriorly during supine sleep.