Considerations of Facial Skeletal Morphology to Optimize Upper Airway Stimulation

Obstructive sleep apnea (OSA) is a chronic condition diagnosed by recurrent episodes of partial or complete upper airway collapse during sleep. This collapse is a result of either a discrepancy between skeletal and soft tissue structures of the airway, increased laxity of the soft tissue, or a combination of both with decreased neuromuscular activity of the airway dilator muscles. The chronicity of OSA is associated with aberrant airway morphology and physiology on multiple levels. Therefore, multi-level surgery shows superior results. Maxillomandibular advancement (MMA) and upper airway stimulation (UAS) are both highly effective multi-level interventions. Their mechanism of action is different but physiologically they are complementary. MMA maintains long-term stability of the velum and lateral pharyngeal wall even in relapse. These patients respond well to UAS. The concept can be extended to the sequencing of the two operations for patients who initially fall outside of UAS eligibility. In this chapter, we discuss the indications for treatment planning patients for MMA followed by UAS.