Morbidity and Mortality Rates After Maxillomandibular Advancement for Treatment of Obstructive Sleep Apnea

Abstract

Purpose To compare morbidity and mortality rates in obstructive sleep apnea (OSA) versus dentofacial deformity (DFD) patients undergoing equivalent maxillofacial surgical procedures. Patients and Methods Patients with OSA who underwent maxillomandibular advancement with genial advancement (MMA), at Massachusetts General Hospital Department of Oral and Maxillofacial Surgery, from December 2002 to June 2011, were matched to patients with DFD undergoing similar maxillofacial procedures during the same time period. They were compared with regards to demographic variables, medical comorbidities, perioperative management, intraoperative, early and late postoperative complications and mortality. Results A study group of 28 patients with OSA and a control group of 26 patients with DFD were compared. The patients with OSA were older (41.9±12.5 vs. 21.7±8.6years), had a higher ASA classification (2.0±0.5 vs. 1.3±0.6) and BMI (29.6±4.7 vs. 23.0±3.1kg/m2). They also had a greater number of medical comorbidities (2.4±2.3 vs. 0.7±1.0). More OSA than DFD patients had complications (28, 100% vs.19, 73%, p=0.003) and the total number of complications in the OSA group was higher (108 vs. 33, p<0.001). In the OSA group, 13.9% and in the DFD group 3.0% of the complications were classified as major. The absolute risk of a complication for the OSA group was 3.9 vs . 1.3 for the DFD group. The relative risk of complications in OSA compared to DFD was 3.0. No difference in mortality was found. Conclusions OSA patients were older, had more comorbidities and ultimately had a greater number of early, late, minor and major complications than those in the DFD group. The incidence of mortality in both groups was zero. MMA appears to be a safe procedure with regards to mortality but OSA patients should be counseled preoperatively regarding the relative increased risk of complications.

“Silent” Sleep Apnea in Dentofacial Deformities and Prevalence of Daytime Sleepiness After Orthognathic and Intranasal Surgery

“…Our study is in agreement with Passeri et al 45 that older DFD patients ($30 years) scheduled to undergo bimaxillary orthognathic surgery are more likely to have symptomatic OSA than younger patients (<30 years). This is not unexpected because weight gain and pharyngeal muscle relaxation tend to occur with age, adding risk for OSA.…”

Strategies for Addressing Mouth-Breathing Treatment with an “Adequate” Nose

“…Interestingly, the authors listed the major complication rate at 13.9%, using major complications as the numerator and total complications as the denominator. Fifteen major complications in 28 patients is a 53.5% major complication rate, most of which were infections per the authors [12].…”

Diagnosis and treatment of obstructive sleep apnea in adults

“…76 However, a retrospective case-control study found that 13.9% of patients had a major complication that required repeat admission or unplanned surgery after maxillomandibular advancement, and numerous minor complications can occur. 77 Regular follow-up to assess for recurrence of OSA is recommended. 75 Laser-assisted uvuloplasty or uvulopalatopharyngoplasty are unreliable for reducing the AHI or improving patient outcomes, and are not recommended.…”