Controversies in Obstructive Sleep Apnea Surgery

Boyd, Scott B.

doi:10.1016/j.coms.2017.07.005

Cited by 15 publications

(38 citation statements)

References 79 publications

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“…MMA could decrease total treatment time and offer faster effective management of OSA, a more favorable cost-to-benefit ratio, and reduced anesthetic and surgical risks. 8 An interesting finding of the present study is the persistence of epiglottis collapse in 43% (n = 6/ 14) of the patients after MMA surgery. Regarding the role of the epiglottis in adult OSA and snoring patients, knowledge is still limited.…”

Section: Discussionsupporting

confidence: 49%

“…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. 41 A common finding is that the radiologic posterior airway space changes significantly after MMA surgery, thereby improving PSG parameters.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 Maxillomandibular advancement (MMA) is the most successful surgical intervention for OSA aside from tracheostomy. 8 MMA involves advancement of both jaws following a Le Fort 1 maxillary osteotomy in conjunction with a bilateral sagittal split osteotomy of the mandible. 9,10 The high success rate of MMA is linked to a decrease in UA collapsibility.…”

Section: Introductionmentioning

confidence: 99%

“…As a result, soft tissues attached to this skeletal framework are thought to be moving forward together with the bony structures. 8,12 The outcomes of MMA surgery have been equated to those of CPAP. 9,10 When non-CPAP treatment is considered, upfront patient selection through UA obstruction analysis is paramount to success, as UA collapse can occur at one or multiple levels, and these levels must be targeted.…”

Section: Introductionmentioning

confidence: 99%

“…9,10 When non-CPAP treatment is considered, upfront patient selection through UA obstruction analysis is paramount to success, as UA collapse can occur at one or multiple levels, and these levels must be targeted. 8,13,14 Assessment of the upper airway in a dynamic way, thereby characterizing the level(s), pattern(s), and degree(s) of collapsibility, has become part of this patient selection. This can be performed by drug-induced sleep endoscopy (DISE) mimicking natural sleep.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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Objectives/Hypothesis To evaluate upper airway (UA) collapse patterns during drug‐induced sleep endoscopy (DISE) and maxillomandibular advancement (MMA) surgery outcome, paying particular attention to the DISE phenotype complete concentric collapse at the level of the palate (CCCp). Study Design Prospective case series. Methods Nineteen patients diagnosed with obstructive sleep apnea (OSA) prospectively underwent mandibular advancement device (MAD) treatment followed by MMA surgery. UA collapse patterns were evaluated before and after MMA surgery. Baseline apnea‐hypopnea index (AHI) was compared with AHI during MAD treatment and after MMA surgery. UA collapse patterns and the presence of baseline CCCp were assessed. AHI differences between patients with and without CCCp after MMA surgery were compared. Results In 14 patients, a full dataset was obtained: 8/6 (male/female), mean age = 51 ± 7 years, body mass index (BMI) = 25.6 ± 3.7 kg/m2, and baseline AHI = 40.2 ± 25.6 per hour of sleep. MMA surgery reduced AHI to 9.9 ± 7.2 per hour of sleep (P = .0001). Eight patients benefited from additional AHI reduction compared to MAD treatment (P = .0113). Six out of 14 (43%) patients showed baseline CCCp. Baseline patient characteristics (age, BMI, and AHI) did not significantly differ between patients with and without CCCp. AHI was equally reduced after MMA, whether (P = .0145) or not (P = .0075) CCCp was present at baseline. All patients showed resolution of CCCp (P = .0159) during postoperative DISE. Conclusions CCCp seems not to be a negative predictor for MMA surgery outcome measured by AHI reduction. Furthermore, MMA is likely to eliminate CCCp. Therefore, MMA might be a solution for OSA patients showing CCCp and broadens the perspective for personalized medicine and combination therapy. However, a large sample is required for definitive results. Level of Evidence 4 Laryngoscope, 130:E268–E274, 2020

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Section: Discussionsupporting

confidence: 49%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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Obstructive Sleep Apnea Syndrome

Menon

2021

Oral and Maxillofacial Surgery for the Clinician

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Obstructive sleep apnea (OSA) is a condition that occurs due to aberrations in the oropharyngeal anatomy and the upper airway dilator muscle physiology with neurocognitive and cardiovascular sequelae. The mandibular-maxillary complex as the causative factor entails the maxillofacial surgeon to diagnose and treat the case when present, using the different treatment modalities available in the armamentarium.

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