Modified Maxillomandibular Advancement for the Treatment of Obstructive Sleep Apnea: A Preliminary Report

Abstract

The preliminary review has demonstrated that the modified MMA technique for the treatment of OSA is highly effective in the treatment of severe OSA without the significant facial profile change commonly associated with the traditional MMA technique.

Non-CPAP therapies in obstructive sleep apnoea

“…In case of maxillomandibular abnormality the advancement must be more pronounced. The classical procedure consists in bilateral sagittal split ramus osteotomies with rigid internal fixation and Le Fort I osteotomy with rigid internal fixation [305][306][307][308][309][310][311][312][313][314][315][316]. The Stanford group [305] performs pharyngoplasty with or without hyoid myotomy suspension (phase I).…”

“…Successful surgery depends on proper patient selection, proper procedure selection and experience of the surgeon [197,318]. (table e31) [305][306][307][308][309][310][311][312][313][314][315][316]. The baseline AHI varied between .20 and .30, success was defined by a post-surgical AHI between ,10 and ,20.…”

“…In all series, patients usually undergo MMA surgery only after a complete clinical and cephalometric examination to evaluate the three major anatomic regions of potential upper airway obstruction: nose, palate (oropharynx) and base of tongue (hypopharynx) [305][306][307][308][309][310][311][312][313][314][315][316]. In some cases, pre-surgical evaluation is performed by a multidisciplinary team including a maxillofacial surgeon, a neurophysiologist and a pulmonologist [308,314].…”

“…In some cases, pre-surgical evaluation is performed by a multidisciplinary team including a maxillofacial surgeon, a neurophysiologist and a pulmonologist [308,314]. Selected patients are often male patients with an AHI .30, aged ,60 yrs, with a BMI ,30 kg?m -2 , and without relevant cardiovascular and pulmonary comorbidities (table e31).…”

Surgical treatment of the sleep apnea Syndrome

“…Many investigators have evaluated secondary facial modifications 4,6,15 . None have reported unsatisfactory results that led patients to regret having had this treatment procedure.…”