How does mandibular advancement with or without maxillary procedures affect pharyngeal airways? An overview of systematic reviews

Tan, Su Keng; Leung, W. Keung; Tang, Alexander Tin Hong; Zwahlen, Roger A.

doi:10.1371/journal.pone.0181146

Cited by 15 publications

(21 citation statements)

References 46 publications

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“…It is reported in the literature that a successful MAD treatment outcome following advancement of the mandible could be a positive predictor for a successful MMA surgery outcome . However, a more recent meta‐analysis considered the degree of maxillary advancement to be a predictor of surgical success rather than successful MAD treatment itself . Studies comparing MAD treatment with MMA surgery for OSA are, nevertheless, limited and inconclusive in this matter.…”

Section: Discussionmentioning

confidence: 99%

“…25,26 However, a more recent meta-analysis considered the degree of maxillary advancement to be a predictor of surgical success rather than successful MAD treatment itself. 11,27,28 Studies comparing MAD treatment with MMA surgery for OSA are, nevertheless, limited and inconclusive in this matter.…”

Section: Discussionmentioning

confidence: 99%

“…41 A common finding is that the radiologic posterior airway space changes significantly after MMA surgery, thereby improving PSG parameters. 28,42 Three-dimensional imaging techniques, such as cone beam computed tomography, magnetic resonance imaging, and/or computational fluid dynamics, also describe such volumetric airway changes and may thus contribute to further understanding of upper airway behavior in OSA patients. 43 Their routine application remains limited due to its static nature and the fact that it is performed during wakefulness, but might serve as an adjunctive UA assessment tool, although not able to take the place of direct dynamic UA endoscopic assessment.…”

Section: Discussionmentioning

confidence: 99%

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Drug‐Induced Sleep Endoscopy Upper Airway Collapse Patterns and Maxillomandibular Advancement

et al. 2019

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Objectives/Hypothesis To evaluate upper airway (UA) collapse patterns during drug‐induced sleep endoscopy (DISE) and maxillomandibular advancement (MMA) surgery outcome, paying particular attention to the DISE phenotype complete concentric collapse at the level of the palate (CCCp). Study Design Prospective case series. Methods Nineteen patients diagnosed with obstructive sleep apnea (OSA) prospectively underwent mandibular advancement device (MAD) treatment followed by MMA surgery. UA collapse patterns were evaluated before and after MMA surgery. Baseline apnea‐hypopnea index (AHI) was compared with AHI during MAD treatment and after MMA surgery. UA collapse patterns and the presence of baseline CCCp were assessed. AHI differences between patients with and without CCCp after MMA surgery were compared. Results In 14 patients, a full dataset was obtained: 8/6 (male/female), mean age = 51 ± 7 years, body mass index (BMI) = 25.6 ± 3.7 kg/m2, and baseline AHI = 40.2 ± 25.6 per hour of sleep. MMA surgery reduced AHI to 9.9 ± 7.2 per hour of sleep (P = .0001). Eight patients benefited from additional AHI reduction compared to MAD treatment (P = .0113). Six out of 14 (43%) patients showed baseline CCCp. Baseline patient characteristics (age, BMI, and AHI) did not significantly differ between patients with and without CCCp. AHI was equally reduced after MMA, whether (P = .0145) or not (P = .0075) CCCp was present at baseline. All patients showed resolution of CCCp (P = .0159) during postoperative DISE. Conclusions CCCp seems not to be a negative predictor for MMA surgery outcome measured by AHI reduction. Furthermore, MMA is likely to eliminate CCCp. Therefore, MMA might be a solution for OSA patients showing CCCp and broadens the perspective for personalized medicine and combination therapy. However, a large sample is required for definitive results. Level of Evidence 4 Laryngoscope, 130:E268–E274, 2020

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Drug‐Induced Sleep Endoscopy Upper Airway Collapse Patterns and Maxillomandibular Advancement

et al. 2019

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“…The main drawback of that study was the fact that they had used lateral cephalograms, which do not give us enough information regarding the PAS dimensions, namely one of the most important aspects, the area of pharyngeal constriction, can only be analyzed on axial slices of CBCT or CT images. In their overview of systematic reviews on the topic of the effect of mandibular advancement on pharyngeal airways, Tan et al [19] concluded that more evidence was needed in order to draw conclusions related to the effect of mandibular advancement on pharyngeal airways.…”

Section: Discussionmentioning

confidence: 99%

Pharyngeal airway changes after mono-maxillary advancement surgery

2018

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Introduction/Objective Maxillary or mandibular retrognathism are common dentofacial deformities treated by combined orthodontic-surgical treatment. Surgical maxillary or mandibular advancement changes the position and strain of surrounding structures, which may also affect pharyngeal airway dimensions. The aim of this study was to evaluate and compare three-dimensional pharyngeal airway space changes in patients treated with maxillary advancement and those treated with mandibular advancement. Methods The sample consisted of 25 patients-12 treated with maxillary advancement and 13 with mandibular advancement surgery. Nasopharyngeal (NP) volume, oropharyngeal (OP) volume, and the area of maximum constriction (AMC) in the OP were measured on cone beam computed tomography scans (2 mA / 120 kV / 12'' FOV) taken before and at least three months after surgery. Paired samples t-test was used for analyzing statistical significance of changes (p ≤ 0.05). Results Postoperative OP and NP volumes, as well as the AMC, increased insignificantly in both groups. Conclusion Results suggest that mono-maxillary surgical advancement of the maxilla or the mandible increases pharyngeal airway dimensions.

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“…MMA has been frequently reported to be an effective method to treat or reduce OSA severity [9,11,35] and has shown a high treatment success rate (> 85%) [36]. Since mandibular setback surgery is in the reverse direction of mandibular advancement, an objective comparison of previous findings for the two different procedures is needed.…”

Section: Improvement Of Airway Patency By Mmamentioning

confidence: 99%

Why most patients do not exhibit obstructive sleep apnea after mandibular setback surgery?

Kim

Kwon

2020

Maxillofac Plast Reconstr Surg

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Maxillomandibular advancement (MMA) is effective for the treatment of obstructive sleep apnea (OSA). In previous studies, the airway was increased in the anteroposterior and transverse dimensions after MMA. However, the effect of the opposite of mandibular movement (mandibular setback) on the airway is still controversial. Mandibular setback surgery has been suggested to be one of the risk factors in the development of sleep apnea. Previous studies have found that mandibular setback surgery could reduce the total airway volume and posterior airway space significantly in both the one-jaw and two-jaw surgery groups. However, a direct cause-and-effect relationship between the mandibular setback and development of sleep apnea has not been clearly established. Moreover, there are only a few reported cases of postoperative OSA development after mandibular setback surgery. These findings may be attributed to a fundamental difference in demographic variables such as age, sex, and body mass index (BMI) between patients with mandibular prognathism and patients with OSA. Another possibility is that the site of obstruction or pattern of obstruction may be different between the awake and sleep status in patients with OSA and mandibular prognathism. In a case-controlled study, information including the BMI and other presurgical conditions potentially related to OSA should be considered when evaluating the airway. In conclusion, the preoperative evaluation and management of co-morbid conditions would be essential for the prevention of OSA after mandibular setback surgery despite its low incidence.

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How does mandibular advancement with or without maxillary procedures affect pharyngeal airways? An overview of systematic reviews

Cited by 15 publications

References 46 publications

Drug‐Induced Sleep Endoscopy Upper Airway Collapse Patterns and Maxillomandibular Advancement

Drug‐Induced Sleep Endoscopy Upper Airway Collapse Patterns and Maxillomandibular Advancement

Pharyngeal airway changes after mono-maxillary advancement surgery

Why most patients do not exhibit obstructive sleep apnea after mandibular setback surgery?

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