Surgical treatment of a patient with obstructive sleep apnea syndrome associated with temporomandibular joint destruction by rheumatoid arthritis

A patient who developed severe sleepiness and sleep apnea in association with adult acquired retrognathia and subluxation of the cervical spine at the level of C3-C4, both resulting from rheumatoid arthritis, is described. The causative factor for upper airway obstruction was a destruction of the temporomandibular joints with retrognathia, which displaced the base of the tongue posteriorly, thus reducing the upper airway lumen. After 12 months of nasal continuous positive airway pressure, definitive treatment consisted of bilateral prosthetic surgical reconstruction of the ramus and the temporomandibular joint. An important increase of upper airway area and normalization of sleep structure were found after therapy. The patient was thus able to discontinue nasal continuous positive airway pressure.