Effect of Maxillomandibular Advancement Surgery on Pharyngeal Airway Volume and Polysomnography Data in Obstructive Sleep Apnea Patients

Abstract

To study volumetric changes in the upper airway in obstructive sleep apnea (OSA) patients after maxillomandibular advancement (MMA) and compare findings to polysomnography (PSG) data of the same patients. Patients and Methods Study consisted of 20 OSA patients (mean age 48 years, range 31-59 years, 1 female, 19 male). Mean SNB and SNA angles before surgery indicated mandibular and maxillary retrognathia. All were treated with MMA including pre-and post-operative orthodontics. Pre-and post-treatment cone-beam computed tomograms (CBCT) were used to measure upper airway volume and PSG data to examine apnea-hypopnea index (AHI), oxygen desaturation index (ODI3/ODI4). In addition, Epworth Sleepiness Scale (ESS), General Health Questionnaire (GHQ-12) and amount of MMA was collected from patient´s files. Results Mean maxillary and mandibular advancement was 4.6±1.9 mm and 9.3±1.7 mm, respectively. Statistically significant increase (mean 64.1%) in the airway volume was found with large individual variation. ODI3/ODI4 and AHI values improved statistically significantly from pre-to post-surgery. ODI3/ODI4 reduced from 12.3±9.8 to 4.0±4.2 and AHI 21.4±13.8 to 5.8±7.2. ESS scores improved (lower scores) post-surgery for majority of patients (n=15) while GHQ-12 scores improved (lower scores) in only six patients. Conclusion Maxillo-mandibular advancement increases upper airway volume and reduces OSA symptoms studied by PSG. MMA can be considered as curative treatment for OSA; however, residual AHI can be found in many patients.

A cirurgia ortognática no tratamento da Apneia Obstrutiva do Sono: Uma revisão integrativa da literatura

“…Apenas cinco dos nove estudos trouxeram os valores do IAH pós-operatório satisfatórios, sendo em média de oito eventos por hora [1][2][3][4]6 deve ser menor que 20 eventos por hora com redução de 50% no pós-operatório 6 . Nesse sentido, a maioria dos estudos incluídos nesta revisão mostrou uma redução significativa nos valores médios do IAH pós-operatório em relação ao IAH préoperatório, relatando uma taxa de sucesso de 65 a 100% 1-3,6,14-17 .…”

“…dispositivos de avanço mandibular e terapia com pressão positiva contínua nas vias aéreas (CPAP) são atualmente as opções de tratamento mais conservadoras e visam o avanço mandibular para aumentar a permeabilidade da via aérea 1,[3][4]6 .…”

“…Nessa perspectiva, é válido analisar o que há na literatura mais recente em âmbito mundial a respeito da realização da cirurgia ortognática em pacientes diagnosticados com AOS, tendo em vista que essa opção de tratamento, embora invasiva, pode ser resolutiva, em contrapartida ao uso do CPAP que, apesar de mais conservador, é algo paliativo e de uso vitalício [1][2][3][4] . Sendo assim, o objetivo desta revisão é fazer um levantamento das evidências científicas mais recentes sobre a eficácia da cirurgia ortognática no tratamento da AOS.…”

Maxillomandibular advancement for obstructive sleep apnea: a retrospective prognostic factor study for surgical response

“…With regard to the maxillary advancement, multiple studies have found no correlation between degree of maxillary advancement and a reduction in AHI [ 35 , 36 ]. Increased airway volume following MMA has been considered to be necessary for improving OSA [ 28 , 37 ], while Chang et al reported that there was a plateau effect for the airway volume increase as a result of maxillary advancement [ 38 ]. In addition to the potential predictors mentioned above, some other factors of interest to clinicians were also investigated in terms of predicting MMA outcome.…”

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“…Thus, mandibular advancement surgeries are very well indicated for patients with sleep apnea and airway problems. In addition, patients with mandibular retrognathism generally present reduced airway volume, and a recent study 25 demonstrated that after the surgical procedure, an average increase of 64% was possible. Therefore, more studies with Early Benefit approaches in patients with skeletal Class II and mandibular retrognathism would be of extreme importance.…”