Lower premolar extraction combined with Herbst treatment for mandibular retrognathia: a risky treatment concept.
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Referrals to pulmonary physicians for polysomnography to evaluate snoring or the possibility of sleep apnea syndrome often evolve into a multidisciplinary clinical problem. We present a young woman with two congenital abnormalities (Marfan's syndrome and retrognathism) which both may affect her decreased exercise tolerance, daytime hypersomnolence, and fatigue. Polysomnography and pulmonary exercise testing documented improvement in her upper airway diameter and exercise capacity. Her improved sleep pattern and her understanding of her exercise performance limitations afforded her a new outlook on life.
A modification of the sagittal ramus split osteotomy for mandibular advancement has been described. It prevents rotation of the distal fragment, simplifies fixation, and reduces lateral pharyngeal edema.
Many techniques have been developed since the first osteotomy for correction of retrognathism was performed in 1905. These techniques have been in two groups--those that are performed in the mandibular body and those that are performed in the mandibular ramus. Ramus procedures are more favored because there is less morbidity in comparison to body procedures. Regardless of the procedure used, an adequate preoperative evaluation based on oral and radiographic examinations, study models, cephalometric analysis, and photographs is mandatory to achieve satisfactory results. A more satisfactory result can almost always be attained if a cooperative effort is made by the oral surgeon and orthodontist in the treatment of retrognathism.
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