Obstructive sleep apnea affects not only the health but the quality of life of a patient. Sleep apnea can be caused by many factors. One of these is the structure of the jawbone, which can be corrected with a surgery that is safe, effective and has been utilized for more than 30 years.

 

When is jaw surgery recommended?

There are two main indications for jaw surgery:

• When sleep apnea is caused by jaw structure or malocclusion, such as mandibular retrognathia, which obstructs the airway. The lower jaw is moved forward and the teeth simultaneously arranged for ideal occlusion.
• When sleep apnea is severe, other treatments have failed, and the patient suffers from a narrow upper airway. In this case, both the upper and lower jaw are moved forward (maxillomandibular advancement), retaining the original occlusion. The upper airway is expanded from the nasal cavity and soft palate down to the hypopharynx, and soft tissue tension is increased, greatly easing breathing.

 

The surgery

The patient will be anesthetized for the procedure. The doctor will then place arch bars over the upper and lower teeth and secure them with wires to maintain the original occlusion. An incision is then made above the gum to expose the upper jaw, which is slid forward and secured with titanium screws. The same procedure is applied to the lower jaw, moving it equidistant to the upper jaw. The surgery takes 2-3 hours in total, and there are no visible incisions afterwards.

 

Recovery

Patients will spend 2-3 nights at the hospital to recuperate. A rubber band will be used to hold the upper and lower jaws in place for about 2-4 weeks. During this period, the patient can only consume liquids. When the bands are removed, they can begin to eat soft foods such as rice porridge without chewing. After 4-6 weeks, if occlusion is normal, the arch bars and wire will be removed, allowing the patient to begin chewing soft foods again. During the recovery period, it is important to maintain good oral hygiene to prevent tooth and gum disease.

 

Are there side effects from the surgery?

• Anesthetizing may cause nausea, vomiting and a sore throat from intubation.
• The surgical incisions may result in pain, a sore throat, difficulty swallowing and bleeding, and patients should sleep with their head elevated at a 30° angle.
• There may be swelling and numbness of the face and particularly lips. Pain around the incisions can be alleviated with ice packs in the first few days, and symptoms should resolve on their own in 1-2 weeks.
• Bleeding in the nasal cavity may lead to a stuffy nose. The doctor may recommend rinsing with saline to clear out congested blood.
• There may be weight loss during the first few weeks because of the limited food intake.
• Some patients may snore due to post-surgical swelling, but this will improve within 2 weeks.
• Some patients have an altered profile after the surgery. Studies show that approximately 70% of patients like their new profile, while 20-25% do not see any change.

 
 

Post-surgery complications

As with any surgery, there may be complications, although the chances are very low:

• Infection
• Excessive bleeding
• Damage to the teeth and roots
• Fracturing of the lower jaw
• Long-term numbness from nerve damage during the procedure
• Bone non-union in patients with poor healing abilities

The Sleep Clinic at Bumrungrad International Hospital is helmed by a team of medical professionals specializing in the diagnosis and treatment of sleep disorders. Treatment ranges from behavior modification therapy to medication to surgery. If you or a loved one have trouble sleeping, consult a doctor: don’t let your quality of life suffer needlessly.