SINDROME DELLE APNEE OSTRUTTIVE DEL SONNO: ANALISI DELL'ACCURATEZZA DELLA PROGRAMMAZIONE DIGITALE SPLINTLESS NELL'AVANZAMENTO MAXILLO-MANDIBOLARE'

Many different clinical presentations are described by the Sleep-Disordered Breathing (SDB). They gradually go from Simple Snoring to the Upper Airway Resistance Syndrome (UARS) up to the Obstructive Sleep Apnea Syndrome (OSAS) with an increased severity. Clinical presentations of the Sleep-Disordered Breathing are several, but they have in common the following features: snoring, morning headaches, daily sleepiness and a general worsening of the cognitive performances. Symptoms are directly proportional to the type of sleeping disorder and to the severity of respiratory obstruction. It needs to be remembered that, eventually, sleeping disorders can evolve into cardiovascular and cerebrovascular complications. OSAS is a clinical condition that, with a multisystemic involvement, could negatively affect life in terms of length and quality. OSAS is certainly the most common SDB, affecting the 1-4% of population. Recent epidemiological studies have showed the high prevalence of the disorder with high rates of delayed or missed diagnosis. The risk factors associated to this clinical condition are high BMI, excessive alcohol consumption, smoking, nasal congestion, menopause and reduced estrogens levels and some medications (eg benzodiazepines). Data in literature show that the risk factor mainly involved in theappearance and progression of OSAS is a BMI >25. It is nowadays known that the treatment of this condition has to be multidisciplinary, both medical and surgical. The maxillo-mandibular advancement (MMA) has been widely confirmed to be a treatment with a success rate of the 90 to 100%, totally comparable to CPAP. The surgical technique of MMA was inherited by orthognathic surgery. The mandible-first approach is demonstrated that it is more beneficial when an anticlockwise rotation and a posterior downgrafting of the maxilla are needed as in OSAS surgery. Moreover, in the last decade, the virtual surgical planning has become a useful tool on a daily basis in orthognathic and OSAS surgery with both CAD-CAM wafers and, more recently, plates and cutting guides. The aim of this prospectivel clinical study is to analyze the accuracy of the virtual planning of MMA in OSAS patients with splintless technique.