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This case report describes the surgical orthodontic treatment of severely retrognathic mandible and mandibular deviation in a patient with a medical history of unilateral subcondylar fracture and temporomandibular joint (TMJ) ankylosis. Because of the severe skeletal deformity of the mandibular ramus on the side with the injury, it was impossible to perform the conventional sagittal split ramus osteotomy (SSRO) on the affected side for the correction of mandibular retrognathia. The patient was treated by Le Fort I osteotomy, mandibular distraction on the affected side, and SSRO on the unaffected side, simultaneously. After treatment, acceptable occlusion and facial esthetics were obtained, though retrognathic mandible and facial asymmetry still remained.

The objectives of this case report are to show how to select the treatment plan for severe mandibular retrognathia and to show the long-term retention follow-up. An adult female with severe retrognathia that might have been caused by arthrosis deformity of the mandibular condyles, was treated with distraction osteogenesis (DO). After presurgical orthodontic treatment, DO was performed to lengthen the retruded mandible. Le Fort I osteotomy and genioplasty were performed to establish functional occlusion and correct her long face, after 5 months of DO. After postsurgical orthodontic treatment, the patient's occlusion had improved markedly, and she exhibited significant aesthetic improvement. Her profile and acceptable occlusion remained stable after 10 years of retention.

Mandibular advancement was studied in 32 patients with mandibular retrognathia in whom the only intervention was in the mandible. Fifteen patients were treated with fixation by lag screws and 17 with monocortical miniplates. Lateral radiographs were taken preoperatively, postoperatively, 2 months postoperatively, and 1.5 years postoperatively, and mandibular movement analysed. All patients healed uneventfully. Cephalometric analysis of lateral radiographs showed no significant differences between the two groups in skeletal relapse during any of the control periods up to 18 months. Mandibular advancement for treatment of mandibular retrognathia using rigid fixation with either lag screws or miniplates was reproducable with only minor skeletal relapse.

CONCLUSIONS, There are gender differences when it comes to the risk factors for sleep apnea. Large tonsils, a high tongue and a wide uvula are risk factors for sleep apnea in men, while large tonsils and a retrognathic mandible are risk factors in women. Upper airway abnormalities including mandibular retrognathia are, however, unable to predict sleep apnea among snorers being investigated for suspected sleep apnea.To identify gender-specific risk factors for obstructive sleep apnea and the diagnostic performance from physical upper airway examinations among snoring men and women investigated because of suspected sleep apnea.The dimensions of the uvula, tonsils, velopharynx and tongue, and nasal septal deviation, mandibular position, neck circumference, weight, and height were systematically scored in 801 consecutive snoring patients (596 men and 205 women), who had been referred for a primary sleep apnea recording.In men, large tonsils, a high tongue, and a wide uvula were independent factors associated with an apnea-hypopnea index of15. In women, large tonsils and mandibular retrognathia were independent factors associated with an apnea-hypopnea index of15. The positive predictive values for upper airway abnormalities ranged between 0.20 and 0.25 in men and between 0.09 and 0.15 in women.