Animated presentation of the Rotation Advancement method
In case of a moderate to severe obstructive sleep apnea, only the so-called "Rotation Advancement” surgery can help. This is a further development of the conventional"bimaxillary surgery"(MMA). It is the most successful surgical method to cure moderate to severe sleep apnea. By this surgical method, a jaw advancement of up to 25 millimeters can be achieved. This occurs not only by a horizontal movement, but also by "rotation" of the jaws. In this method, a complete cure of obstructive sleep apnea is achieved because this surgical treatment widens the upper airways most.
Animated presentation of a rotation advancement method using photo of an operated patient of the Klinik Professor Sailer. This video explains implicitly the complex intervention leading to the cure of obstructive sleep apnea.
The differences in conventional (bimaxillary) jaw surgery to the bimaxillary Rotation Advancement by Prof. Sailer:
Bimaxillary Rotation Advancement
developed by Professor Sailer:
In this method, an anti-clockwise rotation of the upper and lower jaw complex is undertaken while, of course, maintaining the position of the teeth.
Advantages of bimaxillary Rotation Advancement
A maximum advancement of the lower jaw is possible, which is also successful with severe OSAS. Movements of approximately 15 to 20 mm or more are possible. The airways open much wider than with the conventional method. Studies on patients who were operated on using bimaxillary Rotation Advancement, (study by Zinser, Zachow, Sailer 2012, International Journal of Maxillofacial Surgery) have shown that the airways are substantially expanded not only in the sagittal, but also in the transverse direction. As far as the Klinik Professor Sailer is aware, comparable studies for the conventional method do not exist.
Since the upper jaw does not need to be unnaturally moved forward, there is also much less widening of the nostrils and formation of a saddle nose. The usually very unaesthetic protrusion of the upper lip directly below the nose area is also avoided.
- Since the upper jaw does not need to be unnaturally moved forward, there is also much less widening of the nostrils and formation of a saddle nose. The usually very unaesthetic protrusion of the upper lip directly below the nose area is also avoided.
- Due to the rotation, there is an additional extension of the nasopharynx, that is, the uppermost portion of the oropharyngeal airway, which does not take place in conventional MMA.
- The bimaxillary Rotation Advancement achieves excellent results in all malformation syndromes involving hypoplasia of the lower and upper jaw, especially the so-called Treacher Collins Syn- drome and all other growth disturbances with extremely receding chins.
The Klinik Professor Sailer never uses the patient’s own bone for the stabilisation of the upper jaw. This is a great advantage because the patient is spared a second operation on the hip. Hip surgery is usually very painful and poses an additional risk of complications. The Klinik Professor Sailer uses lyophilized bone bank bones for defect bridging in the “Le Fort I-Osteotomy line” area.
The procedure is restricted to highly experienced surgeons. Additional training at the Klinik Professor Sailer is recommended to learn the surgical method. The surgeon must also master the handling of bank bone blocks and jaw distraction.
Conventional bimaxillary surgery
(maxillomandibular advancement / MMA):
The movement of the upper and lower jaw is mostly straightforward, usually aiming for only a 5 to 10 mm advancement in the upper (maxilla) and lower jaw (mandible). A movement of less than 10 mm in the area of the lower jaw where the tongue is attached is insufficient in most cases. The upper jaw must also be moved forward by 10 mm. However, due to the anatomical situation and the blood circulation in the upper jaw, this poses a high risk and in many cases is not possible. Scientific studies make clear that it is the advancement of the lower jaw that is significant, and not that of the upper jaw. Using the conventional method, the upper jaw must be moved as far forward as the mandible, otherwise the teeth will no longer be properly aligned.
Disadvantage of the conventional bimaxillary surgical method:
- A relatively small advancement of 5 to 10 mm for the lower jaw. If a severe OSAS requires a greater advancement, an improvement of the AHI can only be expected, but not a cure.
- The advancement of the upper jaw in OSAS of 5 to 10mm creates a less aesthetic overall appearance. This causes a very broad nose which is at the same time too high. This results in a so-called “snub nose” or “saddle nose”. Some OSAS patients who were operated on by conventional maxillomandibular advancement were disturbed by the protrusion of their upper lip, thereby creating the impression of an “ape-like physiognomy”.