Long‐term Results for Maxillomandibular Advancement to Treat Obstructive Sleep Apnea: A Meta‐analysis

Abstract

Objective To examine outcomes in the intermediate term (1 to <4 years), long term (4 to <8 years), and very long term (≥8 years) for maxillomandibular advancement (MMA) as treatment for obstructive sleep apnea (OSA). Data Sources The Cochrane Library, Google Scholar, Embase, Cumulative Index to Nursing and Allied Health, and PubMed/MEDLINE. Review Methods Three authors systematically reviewed the international literature through July 26, 2018. Results A total of 445 studies were screened, and 6 met criteria (120 patients). Thirty-one patients showed a reduction in apnea-hypopnea index (AHI) from a mean 48.3 events/h (95% CI, 42.1-54.5) pre-MMA to 8.4 (95% CI 5.6, 11.2) in the intermediate term. Fifty-four patients showed a reduction in AHI from a mean 65.8 events/h (95% CI, 58.8-72.8) pre-MMA to 7.7 (95% CI 5.9, 9.5) in the long term. Thirty-five showed a reduction in AHI from a mean 53.2 events/h (95% CI 45, 61.4) pre-MMA to 23.1 (95% CI 16.3, 29.9) in the very long term. Improvement in sleepiness was maintained at all follow-up periods. Lowest oxygen saturation improvement was maintained in the long term. Conclusion The current international literature shows that patients with OSA who were treated with MMA maintained improvements in AHI, sleepiness, and lowest oxygen saturation in the long term; however, the mean AHI increased to moderate OSA in the very long term. Definitive generalizations cannot be made, and additional research providing individual patient data for the intermediate term, long term, and very long term is needed.

Obstructive sleep apnea: transition from pathophysiology to an integrative disease model

“…Both structures are advanced by ~10 mm and fixed in this new position. Patients with OSA who have been appropriately selected for this intervention may have a lasting improvement in EDS and AHI, among other variables (Camacho et al, 2019). Finally, bariatric surgery can be an appropriate remedy for obese patients with OSA in whom dietary regimens have failed.…”

“…However, because both elements of this relationship are highly prevalent in the general population, the default hypothesis should rather be that the association is based on coincidence. Other factors have to be introduced into this model to enhance specificity, i.e., to increase the degree of certainty regarding causality intervention may have a lasting improvement in EDS and AHI, among other variables (Camacho et al, 2019).…”

Alternative Approaches to Adenotonsillectomy and Continuous Positive Airway Pressure (CPAP) for the Management of Pediatric Obstructive Sleep Apnea (OSA): A Review

“…Short-term data are very promising, but emerging data on longer-term follow-up greater than 8 years does show a trend towards at least a ten-point increase in AHI after the immediate improvement. In the case of one cohort by Vigneron et al, the AHI increased to 25.5 at approximately 13 years after MMA, which would qualify as surgical failure by typical definitions [ 57 , 58 ]. In a cohort of 9 patients from an initial cohort of 12 followed for a median of 19 years, successfully treated patients showed no significant symptoms of sleepiness or change in quality of life measures covering headaches, concentration, insomnia, or snoring despite two patients relapsing to prior to procedure AHI values [ 59 ].…”

Effect of Maxillomandibular Advancement Surgery on Pharyngeal Airway Volume and Polysomnography Data in Obstructive Sleep Apnea Patients

“…Several investigators 1 have shown the efficacy of MMA surgery in improving quality of life of patients suffering from such conditions. In recent years MMA surgery has been advocated as a highly effective and curative method for the treatment of obstructive sleep apnea (OSA) 2,3,4 .…”