Pat Ricalde, MD, DDS, FACS
Patient History
• 51-year-old, white female.
• History of hypertension.
• Previously smoked 2 packs per week.
• Lifetime problems with snoring. Was diagnosed with obstructive sleep apnea (OSA) 20 years ago.
• A pre-op sleep study session conducted by her referring physician in 1993 reported 214 apneas and hypoapneas, 94 of which were obstructive.
• At that time, she had no stage III sleep and no REM sleep. Oxygen saturation level was down to 82%, but improved with nasal continuous positive airway pressure.
• The patient at that time had an apnea-hypoapnea index of 73 events per hour.
• Patient was unsatisfied after several years of using a continuous positive airway pressure (CPAP) system and was searching for a permanent solution for the condition.
• Researching on her own, she contacted Dr. Ricalde regarding maxillomandibular advancement (MMA).
Treatment
After a complete examination, Dr. Ricalde determined the patient was an ideal candidate for MMA – a procedure performed to increase airway flow for sleep breathing disorders such as sleep apnea. MMA is considered one of the most effective surgical treatments for sleep apnea, due to
its success rate of more than 90%.
Maxillomandibular advancement surgery has the benefits of correcting the patient’s facial and occlusal deformities while also addressing sleep apnea symptoms by pulling the base of the tongue and soft palate forward, thus increasing the posterior airway space (PAS).
After MMA Surgery
Before MMA Surgery
Surgical Summary:
• Patient had braces placed on teeth to prepare for surgery.
• After a 3-dimentional assessment, the surgical plan was created and discussed with the patient.
• Under general anesthesia, aLe Fort I level maxillary osteotomy was performed, moving the maxilla forward 11 mm.
• A septoplasty and reduction of inferior turbinates was performed.
• A sagittal split ramus osteotomy was performed bilaterally, moving the mandible forward 17 mm.
• A genioplasty was then performed to advance the chin 9 mm.
• Patient remained in hospital for 2 nights.
Outcome:
The patient stayed at home for 3 weeks and resumed all normal activities after 5 weeks.
A sleep study conducted 5 months post-surgery by the referring physician concluded:
• The patient had 2 central apneas for a hypoapnea index of 3.1 events per hour.
• The patient now only snores 17% of the time
• Throughout the study, the oxygen saturation level never dropped below 92%
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