Evaluation of Mandibular Wing Osteotomy in Obstructive Sleep Apnea Cases with Retrognathia

Abstract

Objective The aim of this study is to evaluate the efficacy of wing osteotomy for treating obstructive sleep apnea (OSA). Materials and MethodsWe performed mandibular wing osteotomy in subjects who had an apnea-hypopnea index (AHI) of more than 15, a previous unresponsive conservative treatment for the OSA, moderate to severe retrognathia and no suggested conventional orthognathic surgery because of dentition or lack of willingness. The subjects were evaluated using the Epworth Sleepiness Scale (ESS), AHI and posterior airway space (PAS) before and 1 year after surgery. Results We evaluated 10 subjects (4 males, 6 females) who underwent wing mandibular osteotomy. The mean age of the subjects was 37.8 ± 7.26 years. Analysis of the data demonstrated a significant change in ESS and AHI 1 year after operation. However, PAS was not changed 1 year after surgery. Results did not show any correlation between age, ESS and AHI before and 1 year after surgery.Conclusion Mandibular wing osteotomy is a novel procedure that improves signs of OSA. It may be a surgical option in retrognathic patients with OSA who are not candidates for conventional maxillomandibular advancement.

Genial tubercle advancement and genioplasty for obstructive sleep apnea: A systematic review and meta-analysis

“…Outcomes for posterior airway space (PAS) were reported for genioplasty in three studies (n = 27) with pre‐ and postoperative M ± SD values of 8.64 ± 2.01 (95% CI 7.88, 9.4) to 11.8 ± 2.51 (95% CI 10.9, 12.8), which corresponds to an increase by 3.2 mm, P value < 0.0001 (Fig. ).…”

“…Outcomes for ESS were reported for isolated genioplasty in one study (n = 10) with pre‐ and postoperative M ± SD values of 16.5 ± 1.64 (95% CI 15.5, 17.5) to 10.7 ± 1.76 (95% CI 9.6, 11.8), which corresponds to a reduction by 5.8 points, P value < 0.0001. For genial tubercle advancement, ESS was only reported in one study (n = 10), with pre‐ and postoperative M ± SD values of 7.7 ± 1.6 (95% CI 6.9, 8.5) to 4.8 ± 1.9 (95% CI 4.0, 5.8), which corresponds to a reduction by 2.9 points, P value < 0.0001.…”

“…After an initial review of the titles and abstracts for 1,207 studies, a total of 69 potentially relevant studies were downloaded in their entirety (Fig. ).…”

“…). After detailed review of each downloaded article, a total of13 studies (119 patients) were included (Table ). Outcomes were reported by four studies (45 patients) in which genioplasty was performed, five studies (24 patients) in which GTA was performed, and four studies (50 patients) in which GTA with hyoid surgery was performed.…”

Maxillofacial surgery in patients with obstructive sleep apnea and snoring

“…The anterior mandibular subapical setback osteotomy combined with bilateral sagittal split osteotomy in the treatment of selected obstructive sleep apnea patients enables maximal mandibular advancement, alleviates pharyngeal narrowing and minimizes the alteration to the mid facial profile that is associated with the traditional maxillomandibular advancement (26). Mandibular wing osteotomy is carried out in 10 subjects at a mean age of 37,8±7,26 years with apnea-hypopnea index >15, previously unresponsive conservative treatment for the obstructive sleep apnea, moderate to severe retrognathia and no suggested conventional orthognathic surgery because of dentition or lack of willingness (27). One year after operation, there is a significant change in the Epworth Sleepiness Scale score and in the apnea-hypopnea index as well.…”