Surgery first: current state of the art orthognathic surgery and its potential as a primary treatment modality in obstructive sleep apnea with concurrent dentofacial deformities

Dentofacial deformities (DFD) and obstructive sleep apnea (OSA) are two entities which can be intricately related and require complex management. It can be argued that in the subset of patients in which these two entities overlap and require intervention, an orthognathic surgery first approach (SFA) should be considered a primary treatment modality. With respect to isolated dentofacifal deformities undergoing orthognathic surgery first, the literature and cases completed by the authors resulted in an overall decrease in orthodontic treatment time, on average one year. This is in comparison to the average orthodontic treatment length in those who undergo orthognathic surgery after completion or near completion of orthodontic treatment. In addition, advantages of this treatment modality are immediate resolution of the dentofacial deformity and easier decompensation of the malocclusion after surgery. In relation to OSA, it is known that orthognathic surgery can decrease the apnea-hypopnea index (AHI) in the range of 50-90% resulting in improvement or resolution of symptoms in approximately 90% of patients. Therefore, in the subset of patients with both OSA and DFD requiring intervention and who undergo surgery first intervention, assessing both objective and subjective outcomes (i.e., improvement in AHI, length of treatment, patient satisfaction and QOL) can be utilized to further evaluate the value in this approach as a primary treatment modality.