Counterclockwise Rotation of the Maxillomandibular Complex for the Correction of Dentofacial Deformities and Sleep Apnea

Patients with obstructive sleep apnea (OSA) commonly have a retruded maxilla and mandible and a high occlusal plane angle (HOP) facial morphology creating a decrease in the oropharyngeal airway resulting in OSA. The focus of this chapter is on the HOP facial morphology; clinical, radiographic, and occlusal diagnostic characteristics; treatment protocols; and outcomes for surgical counterclockwise rotation (CCWR) of the maxillomandibular complex. Common temporomandibular joint (TMJ) pathologies are presented that can be contributory to the development of OSA as well as postsurgical relapse if the orthognathic surgery is performed and the TMJ pathology ignored. Treatment protocols are presented to address the jaw deformity requiring CCWR of the maxillomandibular complex as well as management protocols for coexisting TMJ pathologies in order to provide highly predictable outcomes.