Craniofacial Orthopedics for Postadolescent OSA Patients

Abstract

When an OSA patient visits orthodontic clinic right after passing through the pubertal growth peak, what kind of craniofacial orthopedic treatment could be served for the patient’s respiratory improvement? In the past, craniofacial management could be accomplished by two-phase approach through the growth modification before the peak height velocity (the first phase), and through the orthognathic surgery after the end of residual growth (the second phase) (Campbell, Angle Orthod 53:175–191, 1983; McNamara, J Clin Orthod 21:598–608, 1987). Currently, however, craniofacial orthopedic treatment can be successfully achieved during the postadolescence up to young adults, with the development of bone-anchored orthopedic appliances (Kircelli et al., Angle Orthod 76:156–163, 2006; De Clerck et al., J Oral Maxillofac Surg 67:2123–2129, 2009). Although residual mandibular growth still can be neither stimulated nor inhibited as intended during this period, nasomaxillary complex (NMC) can be sagittally and transversely expanded or vertically inhibited by means of microimplants or miniplates. For the postadolescent OSA patients, therefore, active orthopedic intervention should be considered instead of just waiting for the time of orthognathic surgery, aiming at upper airway enlargement and respiratory improvement as early as possible.

In this chapter, temporary anchorage devices (TADs)-assisted orthopedic treatment targeting the NMC will be discussed focusing on the airway development consisting of sagittal protraction, transverse expansion, and vertical inhibition of NMC.