A surgical protocol in the treatment of obstructive sleep apnea syndrome (OSAS) is presented. Eighteen patients with particular craniofacial characteristics consisting in maxillomandibular retroposition or retromandibulism underwent bimaxillary advancement by way of Lefort I and bilateral sagittal ramus osteotomies. Adjunctive procedures (genioplasty, uvuloplasty, and glossoplasty) were performed in the same surgical procedure. In all cases, the patients were evaluated before and 6 months after surgery by a physical examination, Delaire cephalometric analysis, and polysomnography. Surgery was considered successful when the postoperative apnea/hypopnea index (AHI) was less than 15/h and with at least a 50% reduction of the initial index. The surgical success rate was 84%. AHI decreased from 54/h (+/-20.7) to 9.66/h (+/-6.67). The results of this study indicate that successful surgical treatment by maxillomandibular advancement with adjunctive procedures at the same operative time is efficient with a high percentage of success when patients are clearly selected.

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