Case Report: Orthognathic surgery combined with distraction osteogenesis for severe obstructive sleep apnea secondary to unilateral temporomandibular joint ankylosis

This case report evaluates the efficacy of combined orthognathic surgery, distraction osteogenesis, and temporomandibular joint surgery for severe obstructive sleep apnea secondary to temporomandibular joint ankylosis. A 33-year-old female presented with right temporomandibular joint ankylosis, limited mouth opening, mandibular retrusion, facial asymmetry, severe OSA (AHI: 94 events/hour, LSaO2: 66%), and chronic cardiac insufficiency. Treatment included distraction osteogenesis with temporomandibular joint arthroplasty to improve mouth opening, facial symmetry, and airway dimensions, followed by bimaxillary orthognathic surgery (Le Fort I osteotomy and genioplasty) to optimize occlusion, facial esthetics, and airway patency. Outcomes were assessed using cephalometric analysis, airway analysis, and CBCT imaging. Significant improvement in mandibular retrusion (ANB angle) and facial symmetry was achieved. Occlusion, airway parameters (volume, AHI, oxygen saturation), and mouth opening improved over a 24-month treatment period. Vertical distraction osteogenesis via ramus osteotomy simultaneously increased ramus height and provided condylar reconstruction. Concurrent genioplasty contributed to the expansion of the pharyngeal airway and upper airway volume. This case demonstrates that a staged protocol combining orthognathic surgery, temporomandibular joint surgery, and distraction osteogenesis can yield favorable outcomes for severe OSA secondary to temporomandibular joint ankylosis. Validation in larger cohorts with longer follow-up is required.