Purpose To compare morbidity and mortality rates in obstructive sleep apnea (OSA) versus dentofacial deformity (DFD) patients undergoing equivalent maxillofacial surgical procedures. Patients and Methods Patients with OSA who underwent maxillomandibular advancement with genial advancement (MMA), at Massachusetts General Hospital Department of Oral and Maxillofacial Surgery, from December 2002 to June 2011, were matched to patients with DFD undergoing similar maxillofacial procedures during the same time period. They were compared with regards to demographic variables, medical comorbidities, perioperative management, intraoperative, early and late postoperative complications and mortality. Results A study group of 28 patients with OSA and a control group of 26 patients with DFD were compared. The patients with OSA were older (41.9±12.5 vs. 21.7±8.6years), had a higher ASA classification (2.0±0.5 vs. 1.3±0.6) and BMI (29.6±4.7 vs. 23.0±3.1kg/m2). They also had a greater number of medical comorbidities (2.4±2.3 vs. 0.7±1.0). More OSA than DFD patients had complications (28, 100% vs.19, 73%, p=0.003) and the total number of complications in the OSA group was higher (108 vs. 33, p<0.001). In the OSA group, 13.9% and in the DFD group 3.0% of the complications were classified as major. The absolute risk of a complication for the OSA group was 3.9 vs . 1.3 for the DFD group. The relative risk of complications in OSA compared to DFD was 3.0. No difference in mortality was found. Conclusions OSA patients were older, had more comorbidities and ultimately had a greater number of early, late, minor and major complications than those in the DFD group. The incidence of mortality in both groups was zero. MMA appears to be a safe procedure with regards to mortality but OSA patients should be counseled preoperatively regarding the relative increased risk of complications.

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We present a case of a 69-year-old woman with multiple complicating comorbidities who developed medication-related osteonecrosis of the jaw secondary to extraction of multiple teeth with a history of intravenous bisphosphonate therapy for metastatic breast cancer requiring staged management with segmental mandibulectomy with placement of external pin fixator with subsequent exchange of this device for a titanium reconstruction plate and a submental island pedicled flap for soft tissue coverage of the bridging reconstruction plate. Once the surgical sites were well-healed that patient would immediately return to a satisfactory functional outcome with ability to tolerate a soft diet. Furthermore, the patient did not have complications (ie, cardiac, pulmonary, venous thromboembolism, sepsis, surgical site infection, reoperation) during her hospitalization and has done well with her long-term recovery.

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