Effectiveness of Maxillomandibular advancement (MMA) surgery in sleep apnea treatment: Case report

Ferraz, Otávio; Guimarães, Thaís; Rossi, Rosa Carrieri; Cunali, Paulo Afonso; Fabbro, Cibele Dal; Chaves, Cauby Maia; Maluly, Milton; Bittencourt, Lia; Tufik, Sérgio

doi:10.1016/j.slsci.2016.07.005

Cited by 6 publications

(7 citation statements)

References 21 publications

(24 reference statements)

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“…In conformity with reports from many authors and their experiences with orthognathic surgery, we can observe, in the vast majority of patients, common symptomatology, clinic and radiographic characteristics such as: snoring, sleepiness, arrhythmia, nasal obstruction, oropharyngeal abnormalities like tonsil hyperplasia, adenoidal enlargement and macroglossia among others 3 , 6 , 9 , 10 .…”

Section: Discussionsupporting

confidence: 89%

“…Al-Moraissi and Wolford 18 , Ferraz et al 6 and Mehra and Wolford 19 concluded that surgical success is attained with an AHI below 10/hour or a higher-than-50% reduction after surgery, while for the cure of the disease the AHI should be lower than 5/h. Such success depends on a maxillomandibular advancement beyond 9.9 mm.…”

Section: Discussionmentioning

confidence: 99%

“…This syndrome results in oxygen desaturation, which in turn provokes an increase in blood pressure due to the need of a greater respiratory effort and an increase in the levels of carbon dioxide in the blood. The resulting hypoxia is linked to a wide range of problems deriving from the oxidative stress as well as to mortality concerning the coronary arteries 3 , 6 .…”

Section: Revision Of the Literaturementioning

confidence: 99%

“…Alternative options include weight control, mandibular protrusion devices and a number of surgical approaches of the upper airways. Patients with OSA have below-average dimensions of the upper airways and the orthognathic surgery allows maxillomandibular repositioning so that, all the muscles involved are moved forward, which results in a volumetric increase of the airway 6 .…”

Section: Introductionmentioning

confidence: 99%

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Surgical treatment of a Pattern I Obstructive Sleep Apnea Syndrome individual - clinical case report

et al. 2017

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Obstructive Sleep Apnea Syndrome (OSA) is a multifactorial disease that highly alters a persons quality of life. It is characterized by the repeated interruption of breathing during sleep, due to an obstruction or the collapse of the upper airways. Since it is a multifactorial etiological disorder, it requires a thorough diagnosis and treatment with an interdisciplinary team, which comprises several professionals such as a surgical dentist, phonoaudiologist, otorhinolaryngologist, sleep doctor, neurologist and physiotherapist. The diagnosis and the degree of severity of the syndrome is determined through a polysomnography examination. After that, the best form of treatment is devised depending on the gravity of the case. In cases of moderate to severe apnea, invasive treatment through surgical procedures such as maxillomandibular advancement remains the preferred option as it increases the posterior air space, reducing and/or eliminating the obstruction. Thus, improving the patients respiratory function and, consequently, his quality of life as it is shown in the clinical case at hand. In which the male patient, facial pattern type I, 41 years of age, diagnosed with moderate OSA (Apnea-Hypopnea Index - AHI of 23.19), decided to have a surgical treatment instead of a conservative one, resulting in the cure of apnea (AHI of 0.3).

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Revision Of the Literaturementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Surgical treatment of a Pattern I Obstructive Sleep Apnea Syndrome individual - clinical case report

et al. 2017

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“…That means all surgical movements (T3-T2) remained stable during the follow-up period (T4-T3) agreeing with previous studies. 19,55,41,30 Furthermore, Nojan et. al., 56 found that there is no significant relapse after genioplasty and bilateral sagittal split osteotomy or genioplasty alone after 12 months when rigid internal fixation is used.…”

Section: Skeletal Changes: All Subjects In Different Time Pointsmentioning

confidence: 99%

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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A study of fluid dynamics parameters for prediction of obstructive sleep apnea

et al. 2018

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Effectiveness of Maxillomandibular advancement (MMA) surgery in sleep apnea treatment: Case report

Cited by 6 publications

References 21 publications

Surgical treatment of a Pattern I Obstructive Sleep Apnea Syndrome individual - clinical case report

Surgical treatment of a Pattern I Obstructive Sleep Apnea Syndrome individual - clinical case report

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

A study of fluid dynamics parameters for prediction of obstructive sleep apnea

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