Counterclockwise Rotation of the Occlusal Plane in the Treatment of Obstructive Sleep Apnea Syndrome

a a t o i s Maxillofacial surgeons are increasingly involved in the surgical management of patients affected by severe obstructive sleep apnea syndrome (OSAS) because of the high success rate of maxillomandibular advancement (MMA). This increase has occurred in the absence of a correlation between the dimensions of the upper airways corresponding to a resolution of OSAS. There is also no mathematical correlation between bimaxillary advancement and resulting change in dimensions of the posterior airway space (PAS). Most surgeons now agree that the best results are achieved by advancing the jaw as much as possible, maintaining an acceptable functional and esthetic result. The criteria for patient seection included severe OSAS patients unsuitable for ndergo conventional procedures and able to receive a aximum advancement. Although MMA is a life-saving treatment in severe SAS patients, esthetic considerations cannot be nelected, because these patients usually exhibit normal raniofacial skeletal morphology. Therefore the limit f the MMA is represented by that beyond which an nacceptable deformity would be created. Technical mprovements are necessary to make extreme bimaxllary advancements more esthetically acceptable. Reent review of opinions held for the last decade rearding the treatment of facial deformity has led us to xploit a method from the past, the counterclockwise otation of the occlusal plane, which was previously sed in correcting severe Class II skeletal deformity