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Sleep apnoea: Jaw correction stops nocturnal breathing interruptions

By Surgical Tribune
March 26, 2019

MUNICH, Germany: Nightly breathing disorders, or sleep apnoea syndrome (SAS), are widespread. According to new studies, 14 per cent of all men and 7 per cent of women suffer from it. If the cause is a receding tongue, a surgical displacement of the upper and lower jaw can effectively stop the suffering. At a press conference at the 136th Congress of the German Society of Surgery (DGCH), experts explained for whom the operation is considered a health insurance benefit and why examinations should absolutely be carried out before the operation. The annual conference is taking place from 26 to 29 March 2019 in Munich under the motto "Full steam ahead - with heart, hand and mind!"

Even if nocturnal respiratory arrests do not lead to suffocation, with SAS the normal course of sleep is severely disturbed, which is physically stressful and can lead to pronounced daytime fatigue. "In the USA, sleep apnoea and the associated lack of sleep are responsible for almost every fifth car accident," said Prof. Matthias Anthuber, President of the DGCH.

In most cases there are anatomical reasons for the SAS. "Then free breathing in supine position is hindered because the tongue body or soft palate falls back and blocks the upper airways," explains Prof. Jürgen Hoffmann, Vice President of the German Society for Oral and Maxillofacial Surgery (DGMKG). Respiratory arrest accelerates the pulse and triggers wake-up reactions, although those affected do not necessarily actually wake up.

If the suffering becomes too great due to tiredness during the day, physical complaints or snoring, the patients go to the doctor. "We now have a wide range of different therapeutic options," says Hoffmann, who works as Medical Director of the Clinic and Polyclinic for Oral and Maxillofacial Surgery at Heidelberg University Hospital.

For overweight patients, the specialists initially recommend weight loss, sometimes in combination with stomach surgery. A plastic splint that fixes the lower jaw together with the body of the tongue at night and prevents it from falling back has been proven to work many times over. "Also a breathing mask is frequently prescribed," DGMKG expert Hoffmann explained. "It keeps the airways clear at night by using pressurised air, but it is sometimes quite unpopular and therefore often remains unused," the surgeon clarifies. For a small number of the patients, a tongue pacemaker that stimulates the cranial nerve under the tongue with weak electrical stimuli, and thus keeps the pharynx open, can be considered.

An operation in which the oral and maxillofacial surgeons advance the upper and lower jaw together with the tongue body can also be extremely successful. "However, it must first be tested step-by-step and clarified whether the procedure is appropriate for the patient," emphasised Hoffmann. This includes the search for the exact cause, which is often carried out in cooperation with the sleep laboratory and other specialist departments such as lung specialists.

"If the method is considered, a test should first be carried out with a plastic splint that pushes the lower jaw forward," said Hoffman. If the splint helps, a bimaxillar osteotomy can be planned, which is the name of the procedure. "The procedure is costly, will be covered by health insurance companies if there is any prospect of success, and shows long-term good results," summarised the Heidelberg-based surgeon.

Prof. Hoffmann will be presenting on this topic at the congress' press conference on Wednesday, 27 March 2019, from 12.00 to 1:00 p.m.

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