Comparative Effectiveness of Maxillomandibular Advancement and Uvulopalatopharyngoplasty for the Treatment of Moderate to Severe Obstructive Sleep Apnea

Abstract

Purpose To directly compare the clinical effectiveness of maxillomandibular advancement (MMA) and uvulopalatopharyngoplasty (UPPP)—performed alone and in combination—for the treatment of moderate to severe obstructive sleep apnea (OSA). Methods The investigators designed and implemented a retrospective cohort study composed of subjects with moderate to severe OSA (baseline AHI >15). The predictor variable was operative treatment and included: MMA, UPPP, and MMA followed by UPPP (UPPP/MMA). The primary outcome variable was the apnea-hypopnea index (AHI) measured preoperatively and 3–6 months postoperatively. Other variables were grouped into the following categories: demographic, respiratory and sleep parameters. Descriptive and bivariate statistics were computed. Results The sample was composed of 106 subjects grouped as follows: MMA (n=37), UPPP (n=34), and UPPP/MMA (n=35) for treatment of OSA. There were no significant differences between the three groups for the study variables at baseline, except for AHI. Surgical treatment resulted in a significant decrease in AHI in each group: MMA (baseline AHI, 56.3 ± 22.6 vs. AHI after MMA, 11.4 ± 9.8; P <0.0001), UPPP/MMA (baseline AHI, 55.7 ± 49.2 vs. AHI after UPPP/MMA, 11.6 ± 10.7; P <0.0001) and UPPP (baseline AHI, 41.8 ± 28.0 vs. AHI after UPPP, 30.1 ± 27.5; P = 0.0057). After adjusting for differences in baseline AHI, the estimated mean change in AHI was significantly larger for MMA compared to UPPP (MMA AHI, −40.5 vs. UPPP AHI, –19.4; P = <0.0001). UPPP/MMA was no more effective than MMA (P = 0.684). Conclusion The results of this study suggest that MMA should be the surgical treatment option of choice for most patients with moderate to severe OSA who are unable to adequately adhere to CPAP.

Long-Term Effectiveness and Safety of Maxillomandibular Advancement for Treatment of Obstructive Sleep Apnea

“…To determine the potential impact of genioglossal advancement (GA) on changes in the AHI scores the study cohort was stratified by patients who did (n = 9) and did not (n = 21) have GA. Genioglossal advancement was performed using standard surgical techniques as previously published. 20,24,38 No significant differences in the preoperative AHI were found between the 2 groups (GA+ preoperative AHI, 52 ± 24 vs GA− preoperative AHI, 47 ± 18, p > 0.05). The mean change in the AHI scores were larger for those patients undergoing concomitant GA, but the magnitude of change did not reach the level of statistical significance (GA+, ∆AHI = −46 ± 22 vs. GA− ∆AHI −34 ± 23, p > 0.05).…”

“…20,24,38 Both maxillary and mandibular osteotomies were stabilized with bone plate and screw fixation.…”

“…When CPAP adherence is defi ned as > 4 hours of nightly use, 46% to 83% of OSA Several short term observational studies show that maxillomandibular advancement surgery (MMA) may be a clinically effective alternative therapy for patients with moderate-to-severe OSA who are not effectively treated with CPAP. [19][20][21][22][23][24][25][26] MMA involves surgical facial advancement by concomitant maxillary and mandibular osteotomies, thus enlarging the caliber of the posterior upper airway space. Although the level of evidence is low, substantial and consistent short-term reductions in the apnea-hypopnea index (AHI) are observed following MMA.…”

Modern trends in Class III orthognathic treatment: A time series analysis

“…Two-jaw surgeries can also help prevent aggravating sleep apnea by advancing the maxilla, thus limiting the amount required to set back the mandible. [19][20][21] This study's predominance of two-jaw approaches for correction of skeletal Class III malocclusion may be due to the fact that this investigation was performed in an academic center. Referrals from general dentists play an important role in maintaining the number of orthognathic surgery patients.…”

Treatment options for obstructive sleep apnea

“…40 Typically seen as a final approach in stepwise phase surgery, and deemed phase II, MMA alone has been shown to be as effective as UPPP and MMA combined. 41 In a review of 234 individuals, 90% of whom were men with a mean BMI of 29.1 kg/m 2 and preoperative mean AHI of 54.4/h, MMA led to 87% reduction in AHI of with a mean postoperative AHI of 7.7/h. [22][23][24] Postsurgical facial aesthetics is generally discussed with the patients prior to the procedure.…”