Large maxillomandibular advancements for obstructive sleep apnea: An operative technique evolved over 30 years

Camacho, Macario; Liu, Stanley Yung‐Chuan; Certal, Victor; Capasso, Robson; Powell, Nelson B.; Riley, Robert

doi:10.1016/j.jcms.2015.05.015

Cited by 64 publications

(51 citation statements)

References 19 publications

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“…The pharyngeal airway space (PAS) can be changed when treating dento-maxillofacial deformities via bilateral sagittal split ramus osteotomy (BSSRO), Le Fort I osteotomy, genioplasty, and so on. [1][2][3][4][5][6] The BSSRO is the most commonly used treatment method to correct mandibular malformations; its impact on the PAS has also attracted a large number of studies. Previous research has proven that BSSRO advance mandibular for treating retrognathism could improve PAS.…”

mentioning

confidence: 99%

Upper Airway Changes After Mandibular Setback and/or Advancement Genioplasty in Obese Patients

Wang

et al. 2017

Journal of Oral and Maxillofacial Surgery

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confidence: 99%

Upper Airway Changes After Mandibular Setback and/or Advancement Genioplasty in Obese Patients

Wang

et al. 2017

Journal of Oral and Maxillofacial Surgery

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“…A large proportion of these were investigations of different modalities and treatment arms for pediatric tonsillectomy (pediatric studies made up 32.2% of all surgical studies). This relative lack of clinical trials exploring surgical treatments of adult OSA is concerning, especially with increasing literature demonstrating the benefit of surgical therapy for OSA . In the future, it is important that surgical options remain an available and investigated part of OSA management.…”

Section: Discussionmentioning

confidence: 99%

“…This relative lack of clinical trials exploring surgical treatments of adult OSA is concerning, especially with increasing literature demonstrating the benefit of surgical therapy for OSA. 5,18,19 In the future, it is important that surgical options remain an available and investigated part of OSA management. This finding of a minor role for ear, nose, and throat specialists in sleep apnea research is consistent with several prior recent studies expressing concern about the diminishing role of our specialty in OSA care.…”

Section: Discussionmentioning

confidence: 99%

Clinical Trials in Obstructive Sleep Apnea: Recognizing Trends and Future Opportunities

Singh

Capasso

et al. 2018

The Laryngoscope

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Objectives/Hypothesis Examine US and international clinical trials in obstructive sleep apnea (OSA) to characterize researchers involved, interventions being studied, and opportunities for future investigation. Study Design Retrospective database review. Methods The information from ClinicalTrials.gov was used to assess OSA clinical trials between 1999 and 2017. Information was gathered on principle investigator (PI) demographics, interventions studied, study funding source, and regional distribution of research institutions. Results There were 813 clinical trials studied. The majority of trials examined continuous positive airway pressure interventions (43.7%), with pharmacotherapies being the second most commonly investigated treatment (19.2%). Surgical interventions made up 10.7% (n = 87) of clinical trials for OSA. Most studies were based internationally (59.9%). PIs were predominantly male (72.0%); 72.7% had an MD and 28.6% had a PhD. There were no significant differences in funding source (National Institutes of Health vs. industry, P = .14) or institutional geography (international vs. US, P = .73) between surgical and nonsurgical studies. Surgical trials were significantly more likely to have a male PI and involve pediatric patients compared to nonsurgical trials (P < .001). Otolaryngologists represented 9.2% of all PIs and had similar rates of NIH funding compared to other medical specialists (P = .22). Conclusions This study provides a broad overview of past, current, and future treatment paradigms for OSA. Sleep surgery, specifically otolaryngology, is a small voice in the overall landscape of clinical trials for OSA. This information can help guide future research efforts and direct our specialty when setting priorities regarding research funding while encouraging a broad and interdisciplinary pursuit. Level of Evidence NA Laryngoscope, 129:1940–1944, 2019

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“…There are several areas of narrowing in the upper airway including the nasal cavity (turbinates [2] and septum [3]), nasopharynx (adenoids), oropharynx, and hypopharynx [4]. Currently there are many medical [5–7] and surgical [8–11] treatment options for OSA with continuous positive airway pressure (CPAP) treatment being the gold standard therapy. Prior to the development of CPAP devices [12] in the 1980s, tracheotomies were performed as the standard of care for treating OSA patients, especially severe OSA patients with significant comorbidities [13].…”

Section: Introductionmentioning

confidence: 99%

Mini Tracheostomy for Obstructive Sleep Apnea: An Evidence Based Proposal

Camacho

Zaghi

Chang

et al. 2016

International Journal of Otolaryngology

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Objective. To search for articles evaluating the use of tracheostomies (either permanent stomas or tracheostomy tubes) in adult obstructive sleep apnea (OSA) patients and to evaluate the potential for the use of mini tracheostomies as treatment for OSA. Study Design. Systematic review. Methods. Nine databases were searched from inception through July 21, 2015. Results. The overall tracheostomy search yielded 516 articles, of which eighteen studies provided polysomnographic data. No study was identified (empty review) for the use of mini tracheostomies for treating OSA. The mini tracheostomy search yielded ninety-five articles which describe findings for either mini tracheostomy kits (inner cannula diameter of 4 mm) or the performance of mini tracheotomies. Six articles described the use of mini tracheostomies as a temporary procedure to relieve acute upper airway obstruction and none described the use for OSA. For tracheostomy stomal sites, suturing the skin directly to the tracheal rings with defatting can minimize stomal site collapse. The smallest tracheostomy stomal size that can successfully treat OSA has not been described. Conclusion. Mini tracheostomies as small as 4 mm have been successfully used in the short term to relieve upper airway obstruction. Given that polysomnography data are lacking, additional research is needed.

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Large maxillomandibular advancements for obstructive sleep apnea: An operative technique evolved over 30 years

Cited by 64 publications

References 19 publications

Upper Airway Changes After Mandibular Setback and/or Advancement Genioplasty in Obese Patients

Upper Airway Changes After Mandibular Setback and/or Advancement Genioplasty in Obese Patients

Clinical Trials in Obstructive Sleep Apnea: Recognizing Trends and Future Opportunities

Mini Tracheostomy for Obstructive Sleep Apnea: An Evidence Based Proposal

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