Airway changes and prevalence of obstructive sleep apnoea after bimaxillary orthognathic surgery with large mandibular setback

Yang, Hye-Won; Jung, Young Eun; Kwon, Ik Jae; Lee, J.-Y.; Hwang, Soon Jung

doi:10.1016/j.ijom.2019.07.012

Cited by 26 publications

(53 citation statements)

References 27 publications

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“…Isso ocorre porque a maxila e a mandíbula são as bases dos tecidos moles da região orofaríngea, assim, seu posicionamento tem importante influência na estabilização destes tecidos. Tal relação é tão importante que a cirurgia ortognática de avanço bimaxilar é um dos tratamentos cirúrgicos mais efetivos para a apnéia obstrutiva do sono (Alcalde et al, 2019;Daluz et al, 2021;Yang et al, 2020).…”

Section: Discussionunclassified

Alterações do volume da via aérea superior após cirurgia bimaxilar para correção de má-oclusão esquelética Classe III: Uma série de casos

Lago

Cordeiro

Klüppel

et al. 2022

RSD

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O objetivo deste estudo foi avaliar o volume de vias aéreas de pacientes com má oclusão esquelética Classe III, submetidos à cirurgia ortognática bimaxilar. A amostra foi composta por 10 pacientes com má oclusão esquelética Classe III, submetidos à cirurgia ortognática bimaxilar. Através da tomografia computadorizada, as medidas volumétricas tridimensionais das vias aéreas foram determinadas utilizando o programa Dolphin Imaging® 11.7 e foram comparadas entre os períodos pré e pós-operatório. Os pacientes foram divididos em dois grupos, (1) diminuição das vias aéreas e (2) aumento das vias aéreas. O grupo 1 apresentou uma redução média de 66,16 ± 52,48 mm² na avaliação bidimensional das vias aéreas e 2311,16 ± 1653,71 mm³ na avaliação tridimensional (p≤ 0,05). Por outro lado, o grupo 2 aumentou 166,5 ± 73,13 mm² e 4116 ± 1323,85 mm³. Não houve correlação entre os valores obtidos com o movimento ósseo, em mm (p≥0,05). Pacientes com deformidade classe III submetidos a cirurgia bimaxilar, a maioria com diminuição das vias aéreas, no entanto, essa diminuição nem sempre ocorre na mesma magnitude para todos os pacientes.

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Section: Discussionunclassified

Alterações do volume da via aérea superior após cirurgia bimaxilar para correção de má-oclusão esquelética Classe III: Uma série de casos

Lago

Cordeiro

Klüppel

et al. 2022

RSD

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“…A narrowing airway can eventually lead to the development of breathing problems and OSA after surgery, as indicated by several studies [3,15,28,33]. Postoperative OSA development after mandibular setback surgery has been reported in several studies [3,4,26]. Table 4 summarizes the information for seven reported cases of OSA after mandibular setback surgery.…”

Section: Significant Airway Reduction After Mandibular Setback Surgerymentioning

confidence: 96%

“…One patient who developed postoperative OSA already had a high BMI and AHI before surgery [26]. Interestingly, even for an underweight patient with a normal AHI (BMI of 18.9, preoperative AHI of 0.2), the AHI was increased to 7 [4]. However, a recent review of previously published systematic reviews suggested that although the development of postsurgical OSA has been reported, there is no clear evidence that confirms a direct cause-and-effect relationship between mandibular setback surgery and OSA development [27].…”

Section: Significant Airway Reduction After Mandibular Setback Surgerymentioning

confidence: 99%

“…In a previous study, two patients with a large mandibular setback (13.7 mm and 12.6 mm) developed mild OSA 6 months after mandibular setback surgery [3]. In addition, a recent study reported that among 12 patients with a mandibular setback exceeding 10 mm, 4 patients developed postoperative OSA, and the apnea-hypopnea index (AHI) was slightly increased significantly after the surgery [4]. Another study found that although subjective symptoms were not exacerbated, objective sleep quality was decreased after mandibular setback surgery [5].…”

Section: Introductionmentioning

confidence: 99%

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Why most patients do not exhibit obstructive sleep apnea after mandibular setback surgery?

Kim

Kwon

2020

Maxillofac Plast Reconstr Surg

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Maxillomandibular advancement (MMA) is effective for the treatment of obstructive sleep apnea (OSA). In previous studies, the airway was increased in the anteroposterior and transverse dimensions after MMA. However, the effect of the opposite of mandibular movement (mandibular setback) on the airway is still controversial. Mandibular setback surgery has been suggested to be one of the risk factors in the development of sleep apnea. Previous studies have found that mandibular setback surgery could reduce the total airway volume and posterior airway space significantly in both the one-jaw and two-jaw surgery groups. However, a direct cause-and-effect relationship between the mandibular setback and development of sleep apnea has not been clearly established. Moreover, there are only a few reported cases of postoperative OSA development after mandibular setback surgery. These findings may be attributed to a fundamental difference in demographic variables such as age, sex, and body mass index (BMI) between patients with mandibular prognathism and patients with OSA. Another possibility is that the site of obstruction or pattern of obstruction may be different between the awake and sleep status in patients with OSA and mandibular prognathism. In a case-controlled study, information including the BMI and other presurgical conditions potentially related to OSA should be considered when evaluating the airway. In conclusion, the preoperative evaluation and management of co-morbid conditions would be essential for the prevention of OSA after mandibular setback surgery despite its low incidence.

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“…Orthognathic surgery refers to straightening of the jaws, during which the jaw may be moved in any direction, including posteriorly. This can be unfavorable for the airway [32][33][34][35]. MMA does incorporate orthognathic needs, but it prioritizes the airway.…”

Section: Preoperative Planningmentioning

confidence: 99%

Maxillomandibular Advancement and Upper Airway Stimulation: Extrapharyngeal Surgery for Obstructive Sleep Apnea

Ibrahim

Riley

et al. 2020

Clin Exp Otorhinolaryngol

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There are many ways to categorize surgery for obstructive sleep apnea (OSA), one of which is to distinguish between intrapharyngeal and extrapharyngeal procedures. While the general otolaryngologist treating OSA is familiar with intrapharyngeal procedures, such as uvulopalatopharyngoplasty and tongue base reduction, extrapharyngeal sleep operations such as maxillomandibular advancement (MMA) and upper airway stimulation (UAS) have evolved rapidly in the recent decade and deserve a dedicated review. MMA and UAS have both shown predictable high success rates with low morbidity. Each approach has unique strengths and limitations, and for the most complex of OSA patients, the two in combination complement each other. Extrapharyngeal airway operations are critical for achieving favorable outcomes for sleep surgeons.

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Airway changes and prevalence of obstructive sleep apnoea after bimaxillary orthognathic surgery with large mandibular setback

Cited by 26 publications

References 27 publications

Alterações do volume da via aérea superior após cirurgia bimaxilar para correção de má-oclusão esquelética Classe III: Uma série de casos

Alterações do volume da via aérea superior após cirurgia bimaxilar para correção de má-oclusão esquelética Classe III: Uma série de casos

Why most patients do not exhibit obstructive sleep apnea after mandibular setback surgery?

Maxillomandibular Advancement and Upper Airway Stimulation: Extrapharyngeal Surgery for Obstructive Sleep Apnea

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