[Differential therapeutic aspects in treatment of obstructive sleep apnea syndrome]

We report the case of a 43-year-old man who suffered from obstructive sleep apnea with excessive daytime sleepiness and nocturnal sweating. His initial apnea index of 60/h improved under treatment with an Esmarch device. Apneas were totally suppressed by nCPAP application with a pressure of only 4 mb, but the patient rejected nCPAP therapy. After two years with the Esmarch device he reported increasing temporomandibular joint pain and Esmarch therapy had to be stopped. A cephalometric evaluation showed good prognosis for maxillomandibular advancement osteotomy, which was performed and which suppressed the apneas completely over a period of more than one year. Indication, surgical technique, and risks are discussed.