Maxillomandibular Advancement in Obstructive Sleep Apnea Syndrome Patients: a Restrospective Study on the Sagittal Cephalometric Variables

Abstract

ObjectivesThe present retrospective study analyzes sagittal cephalometric changes in patients affected by obstructive sleep apnea syndrome submitted to maxillomandubular advancement.Material and Methods15 adult sleep apnea syndrome (OSAS) patients diagnosed by polysomnography (PSG) and treated with maxillomandubular advancement (MMA) were included in this study. Pre- (T1) and postsurgical (T2) PSG studies assessing the apnea/hypopnea index (AHI) and the lowest oxygen saturation (LSAT) level were compared. Lateral cephalometric radiographs at T1 and T2 measuring sagittal cephalometric variables (SNA, SNB, and ANB) were analyzed, as were the amount of maxillary and mandibular advancement (Co-A and Co-Pog), the distance from the mandibular plane to the most anterior point of the hyoid bone (Mp-H), and the posterior airway space (PAS).ResultsPostoperatively, the overall mean AHI dropped from 58.7 ± 16 to 8.1 ± 7.8 events per hour (P < 0.001). The mean preoperative LSAT increased from 71% preoperatively to 90% after surgery (P < 0.001). All the patients in our study were successfully treated (AHI < 20 or reduced by 50%). Cephalometric analysis performed after surgery showed a statistically significant correlation between the mean SNA variation and the decrease in the AHI (P = 0.01). The overall mean SNA increase was 6°.ConclusionsOur findings suggest that the improvement observed in the respiratory symptoms, namely the apnea/hypopnea episodes, is correlated with the SNA increase after surgery. This finding may help maxillofacial surgeons to establish selective criteria for the surgical approach to sleep apnea syndrome patients.

Cephalometric analysis of the pharyngeal airway space after maxillary advancement surgery

“…In general, maxillomandibular retrusion tends to markedly decrease the pharyngeal airway space (PAS). Several studies have reported that MMA surgery is effective for improving the PAS in such patients [2,3]. Genioplasty surgery, including MMA, is also believed to increase PAS by promoting muscle changes [4,5].…”

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

“…DISE is not yet routinely performed prior to MMA, as opposed to awake lateral cephalograms. 31,[38][39][40] However, cephalometry has several important limitations when applied to the upper airway, resulting in conflicting reports. 8,41 Some studies show no predictive value of specific cephalometric parameters, whereas others do link some parameters to success.…”

Objective and Subjective Outcomes Following Maxillomandibular Advancement Surgery for Treatment of Patients With Extremely Severe Obstructive Sleep Apnea (Apnea-Hypopnea Index >100)

“…10 Studies have found that MMA is an effective surgical treatment for moderate and severe OSA, especially when patients present with a retro positioned maxillomandibular complex 19,23,24 . These studies have included patients with AHIs greater than 15.…”

“…technique for treatment of moderate to severe OSA 16,[19][20][21][22][23][24] . MMA surgery increases the…”