Chapters Transcript Surgical treatment for obstructive sleep apnea Oral and maxillofacial surgeons Christopher F. Viozzi, M.D., D.D.S., James M. Van Ess, M.D., D.D.S., and Jonathan Fillmore, M.D., D.M.D., discuss the multidisciplinary and innovative approach they take to surgically treating obstructive sleep apnea. Studies have shown that roughly 25 to even up to 35 36% of our population has sleep apnea of various degrees. We really have to exhaust non surgical care because that's the gold standard and we don't want to do surgery on anybody if we can get them to tolerate a non surgical therapy for more severe sleep apnea cases or moderate severe sleep apnea cases. We usually recommend surgical treatments when non surgical treatments have failed. We have done jaw surgery here at Mayo for over 50 years. As a matter of fact, the first osteotomy or upper jaw procedure was done in 1967. Here. The first lower jaw uh procedure that we do as we see it today was done in 1970. It's really important to have a multidisciplinary approach. In order to treat sleep apnea, there are several potential complications or challenges with the complexity of sleep surgery. And so it's really important to have a full team who's got experience managing some of those challenges in our own practice. Here. There are patients who we see who never were able to even begin to try CPAP because of claustrophobia or anxiety. And we have other patients that have tried for quite a long time to utilize CPAP without success. And so there's variability in when the external physician or sleep physician or whomever decides to refer jaw surgery for sleep apnea is a really successful treatment because it addresses the airway at multiple levels. I think the patient needs to work very carefully with their trusted sleep physician that's critical that if they have a strong relationship, their sleep physician will help guide them to that decision at the appropriate time. We are able to now plan these operations on the facial skeleton in the computer. There are 3d printed guides that help us accurately cut and avoid certain anomic structures. There are guides that can help us position the jaws and exactly the amount of repositioning that we need to open the airway adequately. And then again, we use these 3D printed titanium plates and screw fixation to hold things in position until everything heals up jaw surgery. For sleep apnoea is a process where a patient will have the upper jaw and then the lower jaw advanced, meaning we bring both jaws usually forward. We use instruments that cut with sound waves and vibration rather than an actual saw or a drill. And so it's more gentle and the recovery is easier. We don't wire patients shut. It's very, very rare that we need to do that. So patients are able to consume a soft diet within a few days after surgery, if you're looking for a surgical consultation for somebody who's got obstructive sleep apnea. One of the advantages of our center is that we see a lot of these cases and that we're extremely comfortable with them and that we can minimize bad outcomes and maximize good outcomes. What we want to do is really help the patient get the best benefit that they can get in terms of treating their disease to prevent complications later in life. Published April 25, 2023 Created by
