[Surgical treatment for obstructive sleep disordered breathing]

The obstructive sleep apnea syndrome is a chronic condition characterized by repeated nocturnal pharyngeal collapse leading to poor-quality sleep and an increased risk of cardiovascular episodes. The classic management by continuous positive-pressure ventilation has its limitations and is not always well tolerated. The treatment alternative comprising an orthotic device is effective in 2/3 of cases, despite the dental limitations and risks inherent in long-term usage. Through a review of the literature, this paper describes the different surgical solutions used to correct obstructive sleep apnea syndrome in adults. The proposed corrections aim to maintain pharyngeal permeability during sleep either by reducing soft tissue volume or by enlarging the facial skeleton or, more recently, by acting on the tone of the pharyngeal dilator muscles. Among these different approaches, the highest success rate was reported for the maxillomandibular advancement procedure. This technique demands rigorous patient selection combined with an appropriate orthodontic work-up and management. Patient selection and the respective benefits and drawbacks of the different approaches are discussed. Indications are reported in the framework of current guidelines.