Seeking Advice on Sleep Apnea Treatment: Exploring Jaw Surgery Options

[Quentin33]

Hello,

I am a new member on the forum and would like to seek opinions on my situation.

I suffer from sleep apnea, mainly hypopneas with an index of 30 per hour and frequent micro-awakenings.

I have undergone treatment with a mandibular advancement device and am currently using continuous positive airway pressure. Despite these treatments, significant fatigue persists.

At the age of 30, my wish is to overcome obstructive sleep apnea syndrome. This led me to explore jaw surgery as it appears to be the only means of curing these apneas.

Attached is an old profile X-ray from 2019.

I consulted with an initial maxillofacial surgeon who cautioned me about the aesthetic risks of surgery. Subsequently, he referred me to an orthodontist to explore orthodontic decompensation solutions. The orthodontist suggests a treatment plan involving the extraction of premolars followed by jaw surgery.

The idea of premolar extraction concerns me even more since, from my understanding, it may increase the risk of sleep apnea.

I fear that if I undergo surgery without premolar extraction, the aesthetic result may not be pleasing.

Additionally, my nasal septum is slightly deviated. Wouldn't a septoplasty be a better option?

What are your thoughts on this?

[kavan]

You look to have somewhat of a low angle (mandibular plane angle) and also have somewhat of a short vertical body of the mandible. It is the type of orientation where if they give you a CCW-r downgraft which is the type that often doesn't require plucking the pre-molars and also the type that will maximize the amount the lower jaw can be advanced forward, you would be left with the trade-off of the lower jaw area looking either 'too short' and the angle getting lower to look 'too low'. That could be the reason behind the surgical suggestion. Plucking out the pre-molars (wisdom tooth might also have to be removed prior to surgery) would allow them to push the lower mandibular teeth backwards and allow more room to advance out the lower jaw. Also, when they do a BSSO (lower jaw advancement) they like the orientation of the lower front teeth to be aligned closer to an upright orientation where yours are angled way to outward of that. Also, it allows them to advance forward along your present MPA (advancement of lower jaw in 'linear' way) which could veer too much from the norm (be too low) if they decreased the angle via the CCW-r method. So, that's why I think you got the suggestion you did.