Obstructive sleep apnea from an oral and maxillofacial surgical perspective: Craniofacial diagnosis and surgical treatment strategies

Obstructive sleep apnea (OSA) is a heterogeneous sleep-related breathing disorder characterized by repetitive upper airway obstruction during sleep. Polysomnography and home sleep apnea testing are used to establish the diagnosis, but these tests alone do not fully identify the anatomical factors responsible for upper airway collapse. Dentists play an important role in evaluating craniofacial skeletal abnormalities, occlusion, tongue position, hyoid position, and upper airway dimensions that may contribute to OSA. This narrative review summarizes the diagnostic process and surgical treatment of adult OSA from an oral and maxillofacial surgical perspective. Clinical examination, lateral cephalometry, computed tomography or cone-beam computed tomography, and drug-induced sleep endoscopy may provide complementary anatomical information. Treatment planning should integrate OSA severity, symptoms, positive airway pressure tolerance, body mass index, craniofacial morphology, dental occlusion, and the site and pattern of upper airway collapse. Maxillomandibular advancement enlarges the skeletal framework surrounding the upper airway and may improve retropalatal and retroglossal obstruction simultaneously. It is one of the most effective surgical treatments for moderate-to-severe OSA, particularly in patients with maxillary or mandibular deficiency, dentofacial deformity, or intolerance to positive airway pressure therapy. However, surgical success should not be determined solely by the amount of skeletal advancement but consider facial aesthetics, occlusal stability, temporomandibular joint status, neurosensory complications, and long-term sleep outcomes. A multidisciplinary and phenotype-based approach is required to select appropriate surgical candidates and achieve stable functional and aesthetic outcomes.