Three-dimensional upper-airway changes with maxillomandibular advancement for obstructive sleep apnea treatment

Schendel, Stephen A.; Broujerdi, J.A.; Jacobson, R.

doi:10.1016/j.ajodo.2014.01.026

Cited by 108 publications

(81 citation statements)

References 26 publications

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“…MMA has been shown to be an effective surgical treatment for patients suffering from OSA 9-14 . The procedures used to advance the maxillomandibular complex in OSA patients are the same as those employed for correction of dentofacial deformities.…”

Section: Discussionmentioning

confidence: 99%

“…9-14 Preoperative evaluation and perioperative risk assessment may differ in the OSA cohort compared to the DFD cohort. In previous surgical studies, OSA patients were more likely to have several common comorbidities including cardiac and vascular disease, hypertension 15-20 , congestive heart failure and stroke 17,18 ; dyslipidemia 17 and diabetes 17 than the general population.…”

Section: Introductionmentioning

confidence: 99%

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Morbidity and Mortality Rates After Maxillomandibular Advancement for Treatment of Obstructive Sleep Apnea

Pásseri

Choi

Kaban

et al. 2016

Journal of Oral and Maxillofacial Surgery

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Purpose To compare morbidity and mortality rates in obstructive sleep apnea (OSA) versus dentofacial deformity (DFD) patients undergoing equivalent maxillofacial surgical procedures. Patients and Methods Patients with OSA who underwent maxillomandibular advancement with genial advancement (MMA), at Massachusetts General Hospital Department of Oral and Maxillofacial Surgery, from December 2002 to June 2011, were matched to patients with DFD undergoing similar maxillofacial procedures during the same time period. They were compared with regards to demographic variables, medical comorbidities, perioperative management, intraoperative, early and late postoperative complications and mortality. Results A study group of 28 patients with OSA and a control group of 26 patients with DFD were compared. The patients with OSA were older (41.9±12.5 vs. 21.7±8.6years), had a higher ASA classification (2.0±0.5 vs. 1.3±0.6) and BMI (29.6±4.7 vs. 23.0±3.1kg/m2). They also had a greater number of medical comorbidities (2.4±2.3 vs. 0.7±1.0). More OSA than DFD patients had complications (28, 100% vs.19, 73%, p=0.003) and the total number of complications in the OSA group was higher (108 vs. 33, p<0.001). In the OSA group, 13.9% and in the DFD group 3.0% of the complications were classified as major. The absolute risk of a complication for the OSA group was 3.9 vs . 1.3 for the DFD group. The relative risk of complications in OSA compared to DFD was 3.0. No difference in mortality was found. Conclusions OSA patients were older, had more comorbidities and ultimately had a greater number of early, late, minor and major complications than those in the DFD group. The incidence of mortality in both groups was zero. MMA appears to be a safe procedure with regards to mortality but OSA patients should be counseled preoperatively regarding the relative increased risk of complications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Morbidity and Mortality Rates After Maxillomandibular Advancement for Treatment of Obstructive Sleep Apnea

Pásseri

Choi

Kaban

et al. 2016

Journal of Oral and Maxillofacial Surgery

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“…A small airway area of about 40 to 67 mm 2 is associated with OSA. 51 In the current study we found that some patients have this criterion as well. This indicates that although not all patients were clinically diagnosed with OSA, they will likely benefit from MMA.…”

Section: Osas Diagnosissupporting

confidence: 62%

Impact on the Pharyngeal Airway Space after Maxillomandibular Advancement Procedure for Obstructive Sleep Apnea Patients

AlSaty¹

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Background and Objectives: Obstructive sleep apnea (OSA) is a sleep-related breathing disorder, characterized by disrupted snoring and repetitive upper airway obstructions. Continuous positive airway pressure (CPAP) is considered the therapeutic mainstay for OSA patients. However, CPAP therapy has compliance limitations. An alternative treatment options is maxillomandibular advancement (MMA) surgical procedure. Genial tubercle advancement (GTA) is often performed concomitant with MMA for esthetic purposes. Cone-beam computed tomography (CBCT) provides the ability to visualize the upper airway and perform three-dimensional (3D) reconstructions. The purpose of this study is to evaluate the impact of MMA procedure with or without GTA on oropharyngeal airway space in OSA patients and the stability after completion of orthodontic treatment. Methods: A total of 25 patients (18 females and 7 males) with a mean age of 37.1 ± 17.3 years were included in the study. CBCT scans were taken before treatment (T1); after pre-surgical orthodontic treatment (T2); immediately after MMA procedure (T3); and at 10 months follow-up visit (T4). Thus, (T2-T1) represented changes due to orthodontic treatment only; (T3-T2) represented changes due to MMA procedure; and (T4-T3) represented changes due to follow-up after surgery. Each patient served as his/her own control. Fifteen of the individuals underwent MMA with GTA. All DICOM files were analyzed using Dolphin 3D Imaging software program to determine total airway volume (TAV), airway area (AA) and minimum axial area (MAA) at explicit regions along the posterior airway space. Dolphin 3D voxel-based superimposition was used to determine the amount of skeletal advancement with MMA and changes after surgery. Results: Significant increase in TAV, AA and MAA was found with MMA treatment (40.61%; 28.77%; and 56.40%, respectively, p<.05). Smaller but significant decrease in TAV, AA and MAA was found during the 10 months follow-up visit (20%; 9.7%; and 26.8%, respectively, p<.05). No significant differences were found in airway measurements with or without GTA procedure. No significant differences were found in any of the airway measurements with or without GTA procedure. The average forward movements of the maxilla, mandible and chin were 6.56 mm and 8.21 mm, 11.42 mm, respectively and less than 1mm relapse was found during the follow-up period. No correlation was found between the magnitudes of skeletal advancement and the change in oropharyngeal airway space (OPAS). Conclusions: Significant increase in OPAS can be expected with MMA surgery with or without GTA procedure in patients diagnosed with OSA. Significant forward movement of the maxilla, mandible and chin positions can be obtained with MMA procedure. A partial loss in OPAS was found during the 10 months follow-up period. The surgical movements were found to be stable with less than 1 mm of relapse during the follow-up period, which was not clinically significant. iii DEDICATIONS To my Father, Saud, even though you are not with us anymo...

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“…The retropalatal space is influenced by the position of the maxilla, soft palate, and tonsils, while the retroglossal space is influenced by the mandibular position and glossal shape and position [11][12][13]. The soft palate is comprised of the musculus uvulae, tensor veli palatini, levator veli palatini, and palatoglossus.…”

Section: Discussionmentioning

confidence: 99%

The Effects of Maxillomandibular Advancement and Genioglossus Advancement on Sleep Quality

Sato¹,

Nakamura²,

Himejima³

et al. 2020

Maxillofacial Surgery and Craniofacial Deformity - Practices and Updates

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Maxillomandibular advancement (MMA) using a standardized surgical procedure consisting of a LeFort I osteotomy and bilateral sagittal split ramus osteotomy and genioglossus advancement (GA) using a genioplasty improve airway volume, oxygen desaturation, and the AHI in patients with OSA. However, there are few reports on changes in sleep quality following MMA and GA. We assessed the effects of MMA and GA on sleep quality by comparing oxygen desaturation, AHI, and sleep architecture before and after surgery. Methods: Eight patients underwent polysomnography (PSG) and CT scan before and after surgery. Conclusions: Our study finds that %TST and %REM were both increased, while %S1 and NA both decreased. Based on these results, it appears that both the quality and quantity of sleep were improved. MMA and GA improve sleep respiratory disturbance and can also improve sleep quality.

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Three-dimensional upper-airway changes with maxillomandibular advancement for obstructive sleep apnea treatment

Cited by 108 publications

References 26 publications

Morbidity and Mortality Rates After Maxillomandibular Advancement for Treatment of Obstructive Sleep Apnea

Morbidity and Mortality Rates After Maxillomandibular Advancement for Treatment of Obstructive Sleep Apnea

Impact on the Pharyngeal Airway Space after Maxillomandibular Advancement Procedure for Obstructive Sleep Apnea Patients

The Effects of Maxillomandibular Advancement and Genioglossus Advancement on Sleep Quality

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