27 Jun Assessment of obstructive sleep apnoea treatment success or failure after maxillomandibular advancement
Maxillomandibular advancement (MMA) is an alternative therapeutic option that may be effective for treating obstructive sleep apnoea (OSA). MMA may provide a solution for OSA patients that have difficulty accepting lifelong treatments with continuous positive airway pressure CPAP or mandibular advancement devices MAS.
Frequent complications observed: The complications most frequently reported following MMA were sensory disturbances in the inferior alveolar nerve (60%) and malocclusion (24%).
Conclusion: The results suggest that age and neck girth may be important factors that could predict susceptibility to OSA treatment failures by MMA. This study reveals new parameters for identifying potential non-responding patients treated with MMA for moderate and severe OSA. Neck circumference and old age were parameters that were found to contribute to failure of MMA. In other words, the greater the neck circumference or higher a patient’s age, the more likely the MMA procedure could fail to adequately decrease AHI (treat OSA). The authors felt that MMA is an effective procedure for reducing AHI, with a moderate risk for major complications or side effects.
Aim: Investigate the different characteristics that determine OSA treatment success/failure after MMA. In order to identify factors that determine the success or failure of OSA patient treatment by MMA a detailed preoperative work-up including AHI, cephalometric analysis, physical examination including neck girth measurements, as well as postoperative information on AHI, complications and side effects were analysed.
Materials and Methods: Single-centre observational study which obtained the data from patients admitted between 2011 and 2015 for elective MMA therapy for moderate and severe OSA.
Results: Sixty-two patients underwent MMA for moderate and severe OSA. Baseline characteristics showed a median age of 54 (47–61) years, BMI was 29 (27–33) kg/m2 and median neck circumference was 43 (40–45) cm. Polysomnographic parameters showed a median AHI preoperative of 52 (36–67). Only 19 patients (31%) had a medical history coinciding with ASA I, 35 patients (57%) with ASA II, and eight patients (13%) with ASA III. The primary outcome formulated as surgical success or failure showed a 71% success rate in our population after MMA when applying the success formula according to Sher. Secondary outcome was defined as a reduction of the AHI after MMA showed a 69% decrease in AHI in our patient population. A statistically significant difference between patient age and neck circumference was found when comparing success vs. failed therapeutic outcomes (P = 0.037 and P = 0.008, respectively). Cephalometric analysis revealed no differences between successful and failed OSA treatment outcomes. There was no difference in maxillary and mandibular advancements between success and failed MMA-treated OSA patients.
de Ruiter MHT, Apperloo RC, Milstein DMJ, de Lange J. Assessment of obstructive sleep apnoea treatment success or failure after maxillomandibular advancement. International Journal of Oral and Maxillofacial Surgery. Volume 46, Issue 11, November 2017, Pages 1357-1362. doi: 10.1016/j.ijom.2017.06.006. Epub 2017 Jul 3.