Mandibular Surgical Procedures

The purpose of this chapter is to present various surgical procedures that can be used in the treatment of a retrognathic mandible that can contribute to obstructive sleep apnea (OSA) by decreasing the oropharyngeal airway. The maxilla is commonly retruded with a high occlusal plane angle facial morphology. This combination of skeletal deformity can displace the tongue posteriorly into the oropharyngeal space severely compromising the functional airway. Patients with OSA may benefit from double jaw orthognathic surgery to advance the maxillomandibular complex forward usually with a counterclockwise rotation that will predictably increase the oropharyngeal airway. Temporomandibular joint (TMJ) surgery may also be indicated to correct coexisting TMJ pathology for predictable and stable outcomes. This chapter focuses only on various mandibular osteotomies that may be incorporated in the management of the adolescent and adult OSA patients. Maxillary osteotomy techniques are presented in another chapter. Particular attention is directed toward the mandibular ramus sagittal split osteotomy, as this is the primary osteotomy technique used for advancing the mandible.