{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T15:06:23Z","timestamp":1780067183745,"version":"3.54.0"},"reference-count":46,"publisher":"The Angle Orthodontist (EH Angle Education & Research Foundation)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>In some severe skeletal Class III patients, mandibular setback surgery using sagittal split ramus osteotomy (SSRO) is performed to correct mandibular protrusion. However, in patients diagnosed with obstructive sleep apnea syndrome (OSAS), the risk of OSAS worsening as a result of the SSRO is very high. Maxillary advancement could reduce the degree of mandibular retropositioning and expand the skeletal framework in the pharyngeal region, leading to enlargement of the airway. However, nasal deformity is an undesirable outcome of the procedure. This case report describes a 23-year-old man with a retruded maxilla and OSAS. The maxillary retrusion was treated using Le Fort I osteotomy with an alar cinch suture and a muco-musculo-periosteal V-Y closure (ACVY). After treatment, better occlusal relationships and improvement in OSAS were observed. Thus, an ACVY could minimize nasolabial deformity.<\/jats:p>","DOI":"10.2319\/052818-406.1","type":"journal-article","created":{"date-parts":[[2019,1,30]],"date-time":"2019-01-30T11:18:18Z","timestamp":1548847098000},"page":"946-952","source":"Crossref","is-referenced-by-count":6,"title":["An orthodontic-orthognathic patient with obstructive sleep apnea treated with Le Fort I osteotomy advancement and alar cinch suture combined with a muco-musculo-periosteal V-Y closure to minimize nose deformity"],"prefix":"10.2319","volume":"89","author":[{"given":"Takayoshi","family":"Ishida","sequence":"first","affiliation":[{"name":"Assistant Professor, Orthodontic Sciences, Department of Orofacial Development and Function, Division of Oral Health Sciences, Graduate School, Tokyo Medical Dental University, Tokyo, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asuka","family":"Manabe","sequence":"additional","affiliation":[{"name":"Graduate Research Student, Orthodontic Sciences, Department of Orofacial Development and Function, Division of Oral Health Sciences, Graduate School, Tokyo Medical Dental University, Tokyo, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shin-Sheng","family":"Yang","sequence":"additional","affiliation":[{"name":"Graduate Student, Orthodontic Sciences, Department of Orofacial Development and Function, Division of Oral Health Sciences, Graduate School, Tokyo Medical Dental University, Tokyo, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenzo","family":"Watakabe","sequence":"additional","affiliation":[{"name":"Graduate Student, Orthodontic Sciences, Department of Orofacial Development and Function, Division of Oral Health Sciences, Graduate School, Tokyo Medical Dental University, Tokyo, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasunori","family":"Abe","sequence":"additional","affiliation":[{"name":"Clinical Fellow, Orthodontic Sciences, Department of Orofacial Development and Function, Division of Oral Health Sciences, Graduate School, Tokyo Medical Dental University, Tokyo, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Ono","sequence":"additional","affiliation":[{"name":"Professor, Orthodontic Sciences, Department of Orofacial Development and Function, Division of Oral Health Sciences, Graduate School, Tokyo Medical Dental University, Tokyo, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1164","reference":[{"key":"i0003-3219-89-6-946-b01","series-title":"Am J Orthod Dentofacial Orthop","first-page":"197","article-title":"Nasal considerations in orthognathic surgery","volume":"100","author":"Schendel \n              SA,","year":"1991","unstructured":"Schendel \n              SA, \n            \n            \n              Carlotti \n              AE\n              Jr. \n            \n          \n          Nasal considerations in orthognathic surgery. Am J Orthod Dentofacial Orthop. 1991;100:197\u2013208."},{"key":"i0003-3219-89-6-946-b02","series-title":"Int J Adult Orthodont Orthognath Surg","first-page":"7","article-title":"Changes in the nasal and labial soft tissues after surgical repositioning of the maxilla","volume":"8","author":"Betts \n              NJ,","year":"1993","unstructured":"Betts \n              NJ, \n            \n            \n              Vig \n              KW, \n            \n            \n              Vig \n              P, \n            \n            \n              Spalding \n              P, \n            \n            \n              Fonseca \n              RJ. \n            \n          \n          Changes in the nasal and labial soft tissues after surgical repositioning of the maxilla. Int J Adult Orthodont Orthognath Surg. 1993;8:7\u201323."},{"key":"i0003-3219-89-6-946-b03","series-title":"J Craniofac Surg","first-page":"734","article-title":"Nasal deformities associated with orthognathic surgery: analysis, prevention, and correction","volume":"18","author":"Altman \n              JI,","year":"2007","unstructured":"Altman \n              JI, \n            \n            \n              Oeltjen \n              JC. \n            \n          \n          Nasal deformities associated with orthognathic surgery: analysis, prevention, and correction. J Craniofac Surg. 2007;18:734\u2013739."},{"key":"i0003-3219-89-6-946-b04","series-title":"J Craniomaxillofac Surg","first-page":"334","article-title":"The effect of alar cinch sutures and V-Y closure on soft tissue dynamics after Le Fort I intrusion osteotomies","volume":"37","author":"Muradin \n              MS,","year":"2009","unstructured":"Muradin \n              MS, \n            \n            \n              Rosenberg \n              A, \n            \n            \n              van der Bilt \n              A, \n            \n            \n              Stoelinga \n              PJ, \n            \n            \n              Koole \n              R. \n            \n          \n          The effect of alar cinch sutures and V-Y closure on soft tissue dynamics after Le Fort I intrusion osteotomies. J Craniomaxillofac Surg. 2009;37:334\u2013340."},{"key":"i0003-3219-89-6-946-b05","series-title":"Biomarkers","first-page":"248","article-title":"Elevated levels of serum chemerin in patients with obstructive sleep apnea syndrome","volume":"17","author":"Feng \n              X,","year":"2012","unstructured":"Feng \n              X, \n            \n            \n              Li \n              P, \n            \n            \n              Zhou \n              C, \n            \n            \n              Jia \n              X, \n            \n            \n              Kang \n              J. \n            \n          \n          Elevated levels of serum chemerin in patients with obstructive sleep apnea syndrome. Biomarkers. 2012;17:248\u2013253."},{"key":"i0003-3219-89-6-946-b06","series-title":"Psychiatry Clin Neurosci","first-page":"659","article-title":"Differential diagnosis of obstructive sleep apnea syndrome patients and snorers using cephalograms","volume":"54","author":"Miyao \n              E,","year":"2000","unstructured":"Miyao \n              E, \n            \n            \n              Miyao \n              M, \n            \n            \n              Ohta \n              T, \n            \n            et al. \n          Differential diagnosis of obstructive sleep apnea syndrome patients and snorers using cephalograms. Psychiatry Clin Neurosci. 2000;54:659\u2013664."},{"key":"i0003-3219-89-6-946-b07","series-title":"Oral Surg Oral Med Oral Pathol Oral Radiol Endod","first-page":"343","article-title":"Relationship between severity of sleep-disordered breathing and craniofacial morphology in Japanese male patients","volume":"107","author":"Ishiguro \n              K,","year":"2009","unstructured":"Ishiguro \n              K, \n            \n            \n              Kobayashi \n              T, \n            \n            \n              Kitamura \n              N, \n            \n            \n              Saito \n              C. \n            \n          \n          Relationship between severity of sleep-disordered breathing and craniofacial morphology in Japanese male patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107:343\u2013349."},{"key":"i0003-3219-89-6-946-b08","series-title":"N Engl J Med","first-page":"1271","article-title":"Sleep apnea\u2014a major public health problem","volume":"328","author":"Phillipson \n              EA.","year":"1993","unstructured":"Phillipson \n              EA. \n            \n          \n          Sleep apnea\u2014a major public health problem. 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Am J Epidemiol. 2001;154:50\u201359."},{"key":"i0003-3219-89-6-946-b10","series-title":"Proc Am Thorac Soc","first-page":"263","article-title":"Diagnostic issues in pediatric obstructive sleep apnea","volume":"5","author":"Muzumdar \n              H,","year":"2008","unstructured":"Muzumdar \n              H, \n            \n            \n              Arens \n              R. \n            \n          \n          Diagnostic issues in pediatric obstructive sleep apnea. Proc Am Thorac Soc. 2008;5:263\u2013273."},{"key":"i0003-3219-89-6-946-b11","series-title":"Sleep Breath","first-page":"269","article-title":"Serum S100A12 levels are associated with the presence and severity of obstructive sleep apnea syndrome in male patients","volume":"18","author":"Shi \n              YK,","year":"2014","unstructured":"Shi \n              YK, \n            \n            \n              Chen \n              JX, \n            \n            \n              Huang \n              Y, \n            \n            \n              Li \n              AY. \n            \n          \n          Serum S100A12 levels are associated with the presence and severity of obstructive sleep apnea syndrome in male patients. Sleep Breath. 2014;18:269\u2013274."},{"key":"i0003-3219-89-6-946-b12","series-title":"Am J Respir Crit Care Med","first-page":"685","article-title":"Obstructive sleep apnea-hypopnea and related clinical features in a population-based sample of subjects aged 30 to 70 yr","volume":"163","author":"Duran \n              J,","year":"2001","unstructured":"Duran \n              J, \n            \n            \n              Esnaola \n              S, \n            \n            \n              Rubio \n              R, \n            \n            \n              Iztueta \n              A. \n            \n          \n          Obstructive sleep apnea-hypopnea and related clinical features in a population-based sample of subjects aged 30 to 70 yr. Am J Respir Crit Care Med. 2001;163:685\u2013689."},{"key":"i0003-3219-89-6-946-b13","series-title":"N Engl J Med","first-page":"1230","article-title":"The occurrence of sleep-disordered breathing among middle-aged adults","volume":"328","author":"Young \n              T,","year":"1993","unstructured":"Young \n              T, \n            \n            \n              Palta \n              M, \n            \n            \n              Dempsey \n              J, \n            \n            \n              Skatrud \n              J, \n            \n            \n              Weber \n              S, \n            \n            \n              Badr \n              S. \n            \n          \n          The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328:1230\u20131235."},{"key":"i0003-3219-89-6-946-b14","series-title":"J Clin Sleep Med","first-page":"263","article-title":"Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults","volume":"5","author":"Epstein \n              LJ,","year":"2009","unstructured":"Epstein \n              LJ, \n            \n            \n              Kristo \n              D, \n            \n            \n              Strollo \n              PJ\n              Jr, \n            \n            et al. \n          Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5:263\u2013276."},{"key":"i0003-3219-89-6-946-b15","series-title":"J Oral Maxillofac Surg","first-page":"2431","article-title":"Effects of mandibular retropositioning, with or without maxillary advancement, on the oro-naso-pharyngeal airway and development of sleep-related breathing disorders","volume":"68","author":"Demetriades \n              N,","year":"2010","unstructured":"Demetriades \n              N, \n            \n            \n              Chang \n              DJ, \n            \n            \n              Laskarides \n              C, \n            \n            \n              Papageorge \n              M. \n            \n          \n          Effects of mandibular retropositioning, with or without maxillary advancement, on the oro-naso-pharyngeal airway and development of sleep-related breathing disorders. J Oral Maxillofac Surg. 2010;68:2431\u20132436."},{"key":"i0003-3219-89-6-946-b16","series-title":"Am J Respir Crit Care Med","first-page":"1322","article-title":"REM sleep-like atonia of hypoglossal (XII) motoneurons is caused by loss of noradrenergic and serotonergic inputs","volume":"172","author":"Fenik \n              VB,","year":"2005","unstructured":"Fenik \n              VB, \n            \n            \n              Davies \n              RO, \n            \n            \n              Kubin \n              L. \n            \n          \n          REM sleep-like atonia of hypoglossal (XII) motoneurons is caused by loss of noradrenergic and serotonergic inputs. Am J Respir Crit Care Med. 2005;172:1322\u20131330."},{"key":"i0003-3219-89-6-946-b17","series-title":"How safe or stable? Br J Oral Maxillofac Surg","first-page":"346","article-title":"Le Fort I advancement osteotomies of 1 cm or more","volume":"54","author":"Bhatia \n              S,","year":"2016","unstructured":"Bhatia \n              S, \n            \n            \n              Bocca \n              A, \n            \n            \n              Jones \n              J, \n            \n            \n              Sugar \n              AW. \n            \n          \n          Le Fort I advancement osteotomies of 1 cm or more. How safe or stable? Br J Oral Maxillofac Surg. 2016;54:346\u2013350."},{"key":"i0003-3219-89-6-946-b18","series-title":"Plast Reconstr Surg","first-page":"171","article-title":"Lip-nasal aesthetics following Le Fort I osteotomy","volume":"81","author":"Rosen \n              HM.","year":"1988","unstructured":"Rosen \n              HM. \n            \n          \n          Lip-nasal aesthetics following Le Fort I osteotomy. Plast Reconstr Surg. 1988;81:171\u2013182."},{"key":"i0003-3219-89-6-946-b19","series-title":"J Oral Maxillofac Surg","first-page":"2438","article-title":"Incidence of complications and problems related to orthognathic surgery","volume":"65","author":"Kim \n              SG,","year":"2007","unstructured":"Kim \n              SG, \n            \n            \n              Park \n              SS. \n            \n          \n          Incidence of complications and problems related to orthognathic surgery. J Oral Maxillofac Surg. 2007;65:2438\u20132444."},{"key":"i0003-3219-89-6-946-b20","series-title":"Oral Surg Oral Med Oral Pathol Oral Radiol Endod","first-page":"24","article-title":"A comparison of neurosensory alteration and recovery pattern among different types of orthognathic surgeries using the current perception threshold","volume":"111","author":"Park \n              JW,","year":"2011","unstructured":"Park \n              JW, \n            \n            \n              Choung \n              PH, \n            \n            \n              Kho \n              HS, \n            \n            \n              Kim \n              YK, \n            \n            \n              Chung \n              JW. \n            \n          \n          A comparison of neurosensory alteration and recovery pattern among different types of orthognathic surgeries using the current perception threshold. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;111:24\u201333."},{"key":"i0003-3219-89-6-946-b21","series-title":"Int J Oral Maxillofac Surg","first-page":"182","article-title":"Peripheral facial palsy after sagittal split ramus osteotomy for setback of the mandible. A case report","volume":"25","author":"Sakashita \n              H,","year":"1996","unstructured":"Sakashita \n              H, \n            \n            \n              Miyata \n              M, \n            \n            \n              Miyamoto \n              H, \n            \n            \n              Miyaji \n              Y. \n            \n          \n          Peripheral facial palsy after sagittal split ramus osteotomy for setback of the mandible. A case report. Int J Oral Maxillofac Surg. 1996;25:182\u2013183."},{"key":"i0003-3219-89-6-946-b22","series-title":"J Craniomaxillofac Surg","first-page":"50","article-title":"Facial palsy after sagittal split osteotomies. A survey of 1747 sagittal split osteotomies","volume":"21","author":"de Vries \n              K,","year":"1993","unstructured":"de Vries \n              K, \n            \n            \n              Devriese \n              PP, \n            \n            \n              Hovinga \n              J, \n            \n            \n              van den Akker \n              HP. \n            \n          \n          Facial palsy after sagittal split osteotomies. A survey of 1747 sagittal split osteotomies. 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Int J Adult Orthodont Orthognath Surg. 1993;8:7\u201323."},{"key":"i0003-3219-89-6-946-b03","series-title":"J Craniofac Surg","first-page":"734","article-title":"Nasal deformities associated with orthognathic surgery: analysis, prevention, and correction","volume":"18","author":"Altman \n              JI,","year":"2007","unstructured":"Altman \n              JI, \n            \n            \n              Oeltjen \n              JC. \n            \n          \n          Nasal deformities associated with orthognathic surgery: analysis, prevention, and correction. J Craniofac Surg. 2007;18:734\u2013739."},{"key":"i0003-3219-89-6-946-b04","series-title":"J Craniomaxillofac Surg","first-page":"334","article-title":"The effect of alar cinch sutures and V-Y closure on soft tissue dynamics after Le Fort I intrusion osteotomies","volume":"37","author":"Muradin \n              MS,","year":"2009","unstructured":"Muradin \n              MS, \n            \n            \n              Rosenberg \n              A, \n            \n            \n              van der Bilt \n              A, \n            \n            \n              Stoelinga \n              PJ, \n            \n            \n              Koole \n              R. \n            \n          \n          The effect of alar cinch sutures and V-Y closure on soft tissue dynamics after Le Fort I intrusion osteotomies. J Craniomaxillofac Surg. 2009;37:334\u2013340."},{"key":"i0003-3219-89-6-946-b05","series-title":"Biomarkers","first-page":"248","article-title":"Elevated levels of serum chemerin in patients with obstructive sleep apnea syndrome","volume":"17","author":"Feng \n              X,","year":"2012","unstructured":"Feng \n              X, \n            \n            \n              Li \n              P, \n            \n            \n              Zhou \n              C, \n            \n            \n              Jia \n              X, \n            \n            \n              Kang \n              J. \n            \n          \n          Elevated levels of serum chemerin in patients with obstructive sleep apnea syndrome. Biomarkers. 2012;17:248\u2013253."},{"key":"i0003-3219-89-6-946-b06","series-title":"Psychiatry Clin Neurosci","first-page":"659","article-title":"Differential diagnosis of obstructive sleep apnea syndrome patients and snorers using cephalograms","volume":"54","author":"Miyao \n              E,","year":"2000","unstructured":"Miyao \n              E, \n            \n            \n              Miyao \n              M, \n            \n            \n              Ohta \n              T, \n            \n            et al. \n          Differential diagnosis of obstructive sleep apnea syndrome patients and snorers using cephalograms. Psychiatry Clin Neurosci. 2000;54:659\u2013664."},{"key":"i0003-3219-89-6-946-b07","series-title":"Oral Surg Oral Med Oral Pathol Oral Radiol Endod","first-page":"343","article-title":"Relationship between severity of sleep-disordered breathing and craniofacial morphology in Japanese male patients","volume":"107","author":"Ishiguro \n              K,","year":"2009","unstructured":"Ishiguro \n              K, \n            \n            \n              Kobayashi \n              T, \n            \n            \n              Kitamura \n              N, \n            \n            \n              Saito \n              C. \n            \n          \n          Relationship between severity of sleep-disordered breathing and craniofacial morphology in Japanese male patients. 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Sleep Breath. 2014;18:269\u2013274."},{"key":"i0003-3219-89-6-946-b12","series-title":"Am J Respir Crit Care Med","first-page":"685","article-title":"Obstructive sleep apnea-hypopnea and related clinical features in a population-based sample of subjects aged 30 to 70 yr","volume":"163","author":"Duran \n              J,","year":"2001","unstructured":"Duran \n              J, \n            \n            \n              Esnaola \n              S, \n            \n            \n              Rubio \n              R, \n            \n            \n              Iztueta \n              A. \n            \n          \n          Obstructive sleep apnea-hypopnea and related clinical features in a population-based sample of subjects aged 30 to 70 yr. Am J Respir Crit Care Med. 2001;163:685\u2013689."},{"key":"i0003-3219-89-6-946-b13","series-title":"N Engl J Med","first-page":"1230","article-title":"The occurrence of sleep-disordered breathing among middle-aged adults","volume":"328","author":"Young \n              T,","year":"1993","unstructured":"Young \n              T, \n            \n            \n              Palta \n              M, \n            \n            \n              Dempsey \n              J, \n            \n            \n              Skatrud \n              J, \n            \n            \n              Weber \n              S, \n            \n            \n              Badr \n              S. \n            \n          \n          The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328:1230\u20131235."},{"key":"i0003-3219-89-6-946-b14","series-title":"J Clin Sleep Med","first-page":"263","article-title":"Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults","volume":"5","author":"Epstein \n              LJ,","year":"2009","unstructured":"Epstein \n              LJ, \n            \n            \n              Kristo \n              D, \n            \n            \n              Strollo \n              PJ\n              Jr, \n            \n            et al. \n          Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5:263\u2013276."},{"key":"i0003-3219-89-6-946-b15","series-title":"J Oral Maxillofac Surg","first-page":"2431","article-title":"Effects of mandibular retropositioning, with or without maxillary advancement, on the oro-naso-pharyngeal airway and development of sleep-related breathing disorders","volume":"68","author":"Demetriades \n              N,","year":"2010","unstructured":"Demetriades \n              N, \n            \n            \n              Chang \n              DJ, \n            \n            \n              Laskarides \n              C, \n            \n            \n              Papageorge \n              M. \n            \n          \n          Effects of mandibular retropositioning, with or without maxillary advancement, on the oro-naso-pharyngeal airway and development of sleep-related breathing disorders. 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