Surgical treatment modality for facial esthetics in an obstructive sleep apnea patient with protrusive upper Hp and acute nasolabial angle

For patients with severe obstructive sleep apnea syndrome (OSAS), maxillomandibular advancement (MMA) offers a good treatment option by physically expanding the skeletal framework. However, facial esthetics can be aggravated by MMA in patients with OSAS who have a normally positioned maxilla, a protrusive upper lip, and an acute nasolabial angle. Therefore, surgical treatment planning should be customized according to diverse skeletodental and soft-tissue patterns to produce a favorable change in facial esthetics and sleep function in patients with OSAS. In this case report, good treatment results were achieved in a young female patient with OSAS and skeletal Class II, a normally positioned maxilla, a protrusive upper lip, and acute nasolabial angle by impaction of the maxilla, autorotation/advancement of the mandible, and advancement of the chin. A customized flowchart for surgical treatment planning in OSAS that considers facial esthetics was suggested. (Angle Orthod. 2013;83:355-363.)