Maxillomandibular Advancement and Tracheostomy for Morbidly Obese Obstructive Sleep Apnea

Abstract

Data for MMA and tracheostomy as treatment for morbidly obese, adult OSA patients are significantly limited. We caution surgeons about drawing definitive conclusions from these limited studies; higher level studies are needed.

Tonsillectomy for adult obstructive sleep apnea: A systematic review and meta-analysis

“…There are over 28 surgeries described for obstructive sleep apnea (OSA) in adults . The success and cure rates for sleep surgeries can be variable; therefore, to improve outcomes, the surgeries are tailored to individual patients based on their facial skeletal anatomy, nasal anatomy (including turbinate size and septal deviations), tonsil size, tongue size, palate position, and body mass index (BMI) . Tonsillectomy is not mentioned as an option as an isolated surgery to treat adult OSA in the American Academy of Sleep Medicine (AASM) practice guidelines .…”

Insights since FDA Approval of Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea

“…Likewise oral appliances are safe, and effective but no cost-effectiveness estimates are available beyond that of the device itself 66 . The most expensive surgical option is mandibular-maxillary advancement but this like tracheostomy is a down-the-line therapy; while it is considered a cure, there is no rigorous objective assessments of cost-effectiveness 67 . What HNS has done is to create another option in OSA management for the CPAP intolerant patient, identify individual factors in determining surgical success, focus definitions of upper airway function, and reenergize surgical interest in OSA.…”

Mini Tracheostomy for Obstructive Sleep Apnea: An Evidence Based Proposal

“…None of the studies discussed mini tracheostomies as a subcategory for tracheostomy technique used for the treatment of OSA. A large percentage of the patients who use tracheostomies as treatment for OSA are obese or morbidly obese [16]. Because of the neck adiposity, many studies have demonstrated that obese OSA patients may have persistent obstruction despite having a tracheostomy tube in place [16].…”

“…Recent meta-analyses have demonstrated that tracheostomies are effective for treating OSA [15], even in morbidly obese patients [16]. Both tubed and tubeless (permanent) tracheostomies are used as treatment for OSA [17].…”