Retrospective Study of 18 Patients Treated by Maxillomandibular Advancement with Adjunctive Procedures for Obstructive Sleep Apnea Syndrome

Smatt, Y; Ferri, Joël

doi:10.1097/01.scs.0000179746.98789.0f

Cited by 78 publications

(25 citation statements)

References 17 publications

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“…In case of maxillomandibular abnormality the advancement must be more pronounced. The classical procedure consists in bilateral sagittal split ramus osteotomies with rigid internal fixation and Le Fort I osteotomy with rigid internal fixation [305][306][307][308][309][310][311][312][313][314][315][316]. The Stanford group [305] performs pharyngoplasty with or without hyoid myotomy suspension (phase I).…”

Section: Maxillomandibular Advancement Rationalementioning

confidence: 99%

“…Successful surgery depends on proper patient selection, proper procedure selection and experience of the surgeon [197,318]. (table e31) [305][306][307][308][309][310][311][312][313][314][315][316]. The baseline AHI varied between .20 and .30, success was defined by a post-surgical AHI between ,10 and ,20.…”

Section: Maxillomandibular Advancement Rationalementioning

confidence: 99%

“…In all series, patients usually undergo MMA surgery only after a complete clinical and cephalometric examination to evaluate the three major anatomic regions of potential upper airway obstruction: nose, palate (oropharynx) and base of tongue (hypopharynx) [305][306][307][308][309][310][311][312][313][314][315][316]. In some cases, pre-surgical evaluation is performed by a multidisciplinary team including a maxillofacial surgeon, a neurophysiologist and a pulmonologist [308,314].…”

Section: Search Criteriamentioning

confidence: 99%

“…While WAITE et al [310] confirmed long-term skeletal stability (12 months) based on cephalometric analysis, PEPIN [325] and others [92,197,[311][312][313][314][315][316][317][318][319][320][321][322][323][324][325][326][327][328][329]] demonstrated a deterioration of the results with a rate of success of 60% on a long-term basis. Ageing and weight gain appear to significantly impair long-term results.…”

Section: Search Criteriamentioning

confidence: 99%

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Non-CPAP therapies in obstructive sleep apnoea

Randerath

Verbraecken²,

Andreas³

et al. 2011

Eur Respir J

311

179

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In view of the high prevalence and the relevant impairment of patients with obstructive sleep apnoea syndrome (OSAS) lots of methods are offered which promise definitive cures for or relevant improvement of OSAS.This report summarises the efficacy of alternative treatment options in OSAS.An interdisciplinary European Respiratory Society task force evaluated the scientific literature according to the standards of evidence-based medicine.Evidence supports the use of mandibular advancement devices in mild to moderate OSAS. Maxillomandibular osteotomy seems to be as efficient as continuous positive airway pressure (CPAP) in patients who refuse conservative treatment. Distraction osteogenesis is usefully applied in congenital micrognathia or midface hypoplasia. There is a trend towards improvment after weight reduction. Positional therapy is clearly inferior to CPAP and long-term compliance is poor. Drugs, nasal dilators and apnoea triggered muscle stimulation cannot be recommended as effective treatments of OSAS at the moment. Nasal surgery, radiofrequency tonsil reduction, tongue base surgery, uvulopalatal flap, laser midline glossectomy, tongue suspension and genioglossus advancement cannot be recommended as single interventions. Uvulopalatopharyngoplasty, pillar implants and hyoid suspension should only be considered in selected patients and potential benefits should be weighed against the risk of long-term side-effects. Multilevel surgery is only a salvage procedure for OSA patients.

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Section: Maxillomandibular Advancement Rationalementioning

confidence: 99%

Section: Maxillomandibular Advancement Rationalementioning

confidence: 99%

Section: Search Criteriamentioning

confidence: 99%

Section: Search Criteriamentioning

confidence: 99%

See 2 more Smart Citations

Non-CPAP therapies in obstructive sleep apnoea

Randerath

Verbraecken²,

Andreas³

et al. 2011

Eur Respir J

311

179

View full text Add to dashboard Cite

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“…OSA subjects achieving surgical success had a mean maxillary advancement of 9.5 mm compared with 7.9 mm for those without success (p= 0.029) while mandibular advancements of over 11mm were still associated with unsuccessful surgical outcomes. 13 However others have noted no association between the degree of maxillary advancement and reduction in AHI after mean overall mandibular advancement of 10.66 mm ± 2.82, and mean maxillary advancement of 5.24 mm ± 1.8 14 . The magnitude of skeletal movements completed in this study were comparable with the above studies: the mean amount of the maxillary advancement measured at upper incisor tip and A point were 9.26 ± 3.06 mm (range, 1.6-15.2) and 9.48 ± 3.02 mm (range, 3-14.8) respectively and the mean mandibular advancement calculated at lower incisor tip was 10.85 ± 2.36 mm (range, 6.3-15.8).…”

Section: Discussionmentioning

confidence: 98%

Skeletal Stability of Patients Undergoing Maxillomandibular Advancement for Treatment of Obstructive Sleep Apnea

Lahey¹

2014

Journal of Oral and Maxillofacial Surgery

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Purpose-To determine long-term stability of maxillomandibular advancement (MMA) in patients with obstructive sleep apnea (OSA).Materials and Methods-This was a retrospective cohort study of patients who underwent MMA and genial tubercle advancement (GTA) for treatment of OSA. Patients were included who were over 19 years of age, had a confirmatory polysomnogram, underwent a LeFort I osteotomy, bilateral sagittal split osteotomies and GTA, had adequate radiographic documentation and at least 11 months follow-up. Exclusion criteria included previous history of orthognathic or other maxillofacial surgery. Predictor variables were presence of OSA treated by MMA, pre and postoperative orthodontia or no orthodontia, length of follow-up and magnitude of advancement. Outcome variable was stability of MMA judged by clinical examination and cephalometric measurements. Standardized lateral cephalometric measurements were done at T0, preoperative; T1 immediate postoperative; T2, latest follow-up >11 months. Differences in cephalometric measurements were calculated between time points T1-T0 and T2-T1 for the overall group and for patients who had orthodontia (Group 1) and those who did not (Group 2). A correlation analysis using length of follow-up and magnitude of advancement as predictor variables of stability were completed. For all analyses, P < .05 was considered statistically significant.Results-During the 9 year study period 120 patients with OSA were evaluated and 112 had operative treatment; twenty-five patients specifically had MMA and GTA, met inclusion criteria and formed the study sample. Mean and range of maxillary and mandibular advancements (T1-T0) were 9.48 mm (range, 1.6-15.2) and 10.85 mm (range, 6.3-15.8) respectively. At T2-T1, no HHS Public Access Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript occlusal changes occurred. Changes in the subgroup analyses included a decrease in SNA and ANB and an increase in MnPl-SN in Group 1 and a decrease in ANB in Group 2. The only significant mean difference in cephalometric measurements between the groups was in Co-Gn. There was no correlation between length of follow-up (mean 27.84 months) and changes in cephalometric measurements.Conclusion-Results of this study indicate that while there were changes in SNA and ANB between T1 and T2 suggesting maxillary relapse, the mean difference was ≤1 degree and no patients developed a malocclusion; therefore we considered the changes clinically insignificant. Advancement of the maxillomandibular complex 10 mm for treatment OSA remains stable at a mean followup period greater than 2 years and preoperative orthodontic treatment does not appear to influence skeletal stability.

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Obstructive Sleep Apnea

Waite¹,

Guffey²

2012

Management of Complications in Oral and Maxillofacial Surgery

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Retrospective Study of 18 Patients Treated by Maxillomandibular Advancement with Adjunctive Procedures for Obstructive Sleep Apnea Syndrome

Cited by 78 publications

References 17 publications

Non-CPAP therapies in obstructive sleep apnoea

Non-CPAP therapies in obstructive sleep apnoea

Skeletal Stability of Patients Undergoing Maxillomandibular Advancement for Treatment of Obstructive Sleep Apnea

Obstructive Sleep Apnea

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