Retrognathia and Sleep Apnea

To the Editor.—  Imes et al reported for the first time sleep and respiratory measurements before and after tracheotomy in a patient with sleep apnea hypersomnolence syndrome associated with retrognathia. The patient also had a posterior displacement of the tongue resulting in sleep obstruction, causing low Po₂ levels with associated cardiac arrhythmias and daytime hypersomnolence. The concluding statement to the article was, "Effective treatment of the sleep apnea hypersomnolence syndrome associated with retrognathia is limited to tracheotomy."We are presently conducting a research study with patients requiring orthognathic surgery, one type which is retrognathic mandibles (notice in N Engl J Med 296:462, 1977). This type of procedure requires the surgical fracturing of the mandible, a realignment in a more anterior position, and postoperative fixation with the mouth being wired closed for a period of weeks. As the mandible is repositioned anteriorly, the tongue is also moved forward by the genioglossis