Korean J Orthod.  2019 Jul;49(4):265-276. 10.4041/kjod.2019.49.4.265.

Maxillomandibular advancement surgery after long-term use of a mandibular advancement device in a post-adolescent patient with obstructive sleep apnea

  • 1Department of Orthodontics, Kyung Hee University Graduate School, Seoul, Korea.
  • 2Department of Orthodontics, Kyung Hee University School of Dentistry, Seoul, Korea. ksj113@khu.ac.kr
  • 3Department of Oral and Maxillofacial Surgery, Kyung Hee University School of Dentistry, Seoul, Korea.
  • 4Department of Otorhinolaryngology Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea.


Patients with obstructive sleep apnea (OSA) whose phenotype belongs to a craniofacial vulnerability are referred from sleep doctors to orthodontists. In adults, for osseo-pharyngeal reconstruction (OPR) treatment, permanent maxillomandibular advancement (MMA) surgery and use of a temporary mandibular advancement device (MAD) are applied. This case report demonstrates successful treatment of OSA through application of phased MAD and MMA in a 16-year-old male with craniofacial deformity and residual growth potential. This patient showed skeletal and dentoalveolar changes after 7-year MAD use throughout post-adolescence, which affected the design and timing of subsequent MMA surgery, as well as post-surgical orthodontic strategy. This case report suggests that OPR treatment can be useful for treatment of OSA in post-adolescent patients, from an orthodontic point of view, in close collaboration with sleep doctors for interdisciplinary diagnosis and treatment.


Obstructive sleep apnea; Maxillomandibular advancement surgery; Mandibular advancement device; Surgery-firtst approach
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