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April 23, 1982

Mandibular Retrognathia and Sleep Apnea

Author Affiliations

Bellflower, Calif

JAMA. 1982;247(16):2234. doi:10.1001/jama.1982.03320410020018

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To the Editor.—  I have read the article "Adverse Effects of Tracheostomy for Sleep Apnea" by Conway et al (1981;246:347). The authors present 11 cases of hypersomnia sleep apnea of obstructive etiology that were treated by tracheostomy. For the most part, their results show dramatic improvement of the manifestations of sleep apnea, but an entire new set of complications ensued, including tracheal complications, infection, and psychosocial difficulties.It has been documented that the upper airway obstruction seen in these patients is sometimes secondary to either a congenital or acquired mandibular retrognathia. The authors list two patients of the 11 in their Table 1 (p 348) with a diagnosis of mandibular retrognathia as the primary underlying disease of these patients' airway obstruction.We believe that an orthognathic evaluation to include cephalometric analysis, model surgery, and postural positioning of the mandible for airway assessment should be accomplished on all patients with hypersomnia