Surgical Maxillofacial Treatment of Obstructive Sleep Apnea

Abstract

Obstructive sleep apnea is the most common sleep-related breathing disorder, with a surprisingly high prevalence. The treatment of choice is nasal continuous positive airway pressure (CPAP) ventilation during sleep, which has to be applied throughout the patient's whole life. Because of various underlying pathomechanisms in patients with certain craniofacial disorders--narrow posterior airway space and maxillary-mandibular deficiency--surgical therapy by craniofacial osteotomies seems possible. A series of 38 consecutive patients were treated by 10-mm maxillomandibular advancement by retromolar sagittal split osteotomy and Le Fort I osteotomy, respectively. Obstructive sleep apnea syndrome was improved considerably in all patients; there was no significant difference compared to the results under nasal CPAP. In 37 of 38 patients, the postoperative apnea-hypopnea index was reduced clearly to under 10 per hour, oxygen saturation rose, and sleep quality improved. This was achieved by maxillomandibular advancement of 10 mm without secondary refinements in all but 2 patients. In one patient, the apnea-hypopnea index could only be reduced to 20 per hour, probably because of insufficient maxillary advancement. These results indicate that successful surgical treatment is possible in a high percentage of selected patients with certain craniofacial characteristics. In addition to cardiorespiratory polysomnography, there should be routine cephalometric evaluation of all patients. Maxillomandibular advancement should be offered as an alternative therapy to all patients with maxillary and/or mandibular deficiency or dolichofacial type in combination with narrow posterior airway space.

Maxillary Protraction Appliance Effect on the Size of the Upper Airway Passage

“…The indications for this procedure are determined by cephalometric and polysomnographic studies. [26][27][28] Ö zbek et al 19 studied the effects of functional-orthopedic treatment on oropharyngeal dimensions of growing patients with Class II malocclusion, and concluded that sagittal dimensions of the upper airway could be increased by functional treatment. Considering that mandibular growth has a definite influence on upper airway dimensions, one may speculate that stimulation of maxillary growth in growing subjects with a retrusive maxilla could also have beneficial effects on the upper airway dimensions.…”

Long-Term Effectiveness and Safety of Maxillomandibular Advancement for Treatment of Obstructive Sleep Apnea

“…When CPAP adherence is defi ned as > 4 hours of nightly use, 46% to 83% of OSA Several short term observational studies show that maxillomandibular advancement surgery (MMA) may be a clinically effective alternative therapy for patients with moderate-to-severe OSA who are not effectively treated with CPAP. [19][20][21][22][23][24][25][26] MMA involves surgical facial advancement by concomitant maxillary and mandibular osteotomies, thus enlarging the caliber of the posterior upper airway space. Although the level of evidence is low, substantial and consistent short-term reductions in the apnea-hypopnea index (AHI) are observed following MMA.…”

Telegnathic Surgery for Obstructive Sleep Apnea

“…Riley et al [65] reported the largest MMA series with success rate of 98%. In 2004 Dattilo and Drooger [66] reported 93% success rate in 14 of 15 cases, whereas Hochban et al in 1997 reported 97% success rate in 37 of 38 cases [67].…”