Genioplasty combined with counterclockwise rotation of the maxillomandibular complex for the treatment of obstructive sleep apnea

Background Genioplasty, whether performed alone or with other procedures, leads to a more balanced and harmonious facial profile, correcting chin dysmorphology and enhancing the lower third of the face. Mandibular retrognathia is recognized as a structural risk factor for OSA. Methods We conducted a retrospective analysis of patients who underwent mandibular advancement and genioplasty for obstructive sleep apnea (OSA), all operated on consecutively by the same surgeon between 2022 and 2024. Two patients were selected for clinical evaluation. The first is a 28-year-old male presenting with a body mass index indicative of mild overweight. The second is a 30-year-old female with a normal body weight. Both patients present with mandibular retrognathia in the presence of a well-positioned maxilla, thereby excluding the need for maxillary advancement. Therapeutic strategies such as counterclockwise rotation of the mandibular plane and genioplasty may be considered effective approaches to enhance facial aesthetics and improve upper airway patency. Pre- and postoperative cephalometric tracings were generated from CT scan images using a dedicate software. Results Following surgical intervention, both patients exhibited substantial improvements across respiratory, oximetric, and skeletal domains. The Apnea–Hypopnea Index (AHI), Apnea Index (AI), and Hypopnea Index (HI) showed marked reductions, transitioning from pathological levels to values consistent with the resolution of obstructive sleep apnea (OSA). Snoring was entirely eliminated in both cases. From an aesthetic standpoint, the patients' facial profiles improved due to a combination of counterclockwise rotation of the maxilla, mandibular advancement, and advancement genioplasty, contributing to enhanced facial harmony and airway patency. Conclusion Advancement genioplasty may be strategically combined with more extensive orthognathic procedures, such as mandibular advancement and counterclockwise rotation of the maxillomandibular complex, to achieve a more pronounced enlargement of the retromandibular space. This combined approach contributes to enhanced upper airway stability, particularly in patients with skeletal deficiencies contributing to obstructive sleep apne advancement genioplasty may be strategically combined with more extensive orthognathic procedures, such as mandibular advancement and counterclockwise rotation of the maxillomandibular complex, to achieve a more pronounced enlargement of the retromandibular space. This combined approach contributes to enhanced upper airway stability, particularly in patients with skeletal deficiencies contributing to obstructive sleep apnea.