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Furundarena-Padrones L, Cabriada-Nuño V, Brunsó-Casellas J, Garcia-Fernandez RI, Castro-Quintas S, Santos-Zorrozúa B, González-Zapico G, Calvo-Guirado JL, De-Carlos-Villafranca F. Correlation between polysomnographic parameters and volumetric changes generated by maxillomandibular advancement surgery in patients with obstructive sleep apnea: a fluid dynamics study. J Clin Sleep Med 2024; 20:371-379. [PMID: 37861401 PMCID: PMC11019223 DOI: 10.5664/jcsm.10874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/13/2023] [Accepted: 10/13/2023] [Indexed: 10/21/2023]
Abstract
STUDY OBJECTIVES Maxillomandibular advancement surgery (MMA) is a therapeutic option for obstructive sleep apnea (OSA). The main objective of this study was to determine the impact of MMA on the physical and airflow characteristics of the upper airway based on data obtained by computational fluid dynamics (CFD) and to correlate these data with polysomnography parameters. Other objectives included the identification of presurgical variables that could help avoid surgeries likely to have a low success rate. METHODS This was a retrospective observational study of 18 patients with moderate-severe OSA who underwent MMA. Polysomnography and computed axial tomography imaging were performed before and after the surgery. Three-dimensional models for CFD study were made based on the images obtained. RESULTS MMA achieved an average increase in airway volume of 43.75%, with a mean decrease in the maximum airway velocity of 40.3%. We found significant correlations between improved apnea-hypopnea index values and both the increase in airway volume and decrease in maximum airway speed. Patients with a maximum velocity of less than 7.2 m/s before the intervention had a high rate of surgical failure (43%). CONCLUSIONS MMA generates a significant increase in the volume of the upper airway, which was associated with improved flow conditions in the CFD simulation. These findings also correlated with improved polysomnography parameters. Thus, CFD simulation on three-dimensional anatomical models of patients with OSA could contribute to the better selection of candidates for MMA. CITATION Furundarena-Padrones L, Cabriada-Nuño V, Brunsó-Casellas J, et al. Correlation between polysomnographic parameters and volumetric changes generated by maxillomandibular advancement surgery in patients with obstructive sleep apnea: a fluid dynamics study. J Clin Sleep Med. 2024;20(3):371-379.
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Affiliation(s)
| | - Valentín Cabriada-Nuño
- Pneumology Service, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Bizkaia, Spain
- Medicine Department, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, Bizkaia, Spain
| | - Joan Brunsó-Casellas
- Maxillofacial Surgery Department, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - Ruben Israel Garcia-Fernandez
- 3D Printing and Bioprinting Laboratory, Biocruces Bizkaia Health Research Institute, Innovation and Quality Department, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - Sonia Castro-Quintas
- Pneumology Service, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Bizkaia, Spain
- Medicine Department, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, Bizkaia, Spain
| | - Borja Santos-Zorrozúa
- Scientific Coordination Unit, Cruces University Hospital, Osakidetza, Barakaldo, Bizkaia, Spain
| | | | | | - Felix De-Carlos-Villafranca
- Surgery and Medical-Surgical Specialties Department, Area of Orthodontics, Faculty of Medicine, University of Oviedo, Oviedo, Spain
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Abdelwahab M, Poomkonsarn S, Ren X, Awad M, Capasso R, Riley R, Most S, Liu SYC. A Comprehensive Strategy for Improving Nasal Outcomes After Large Maxillomandibular Advancement for Obstructive Sleep Apnea. Facial Plast Surg Aesthet Med 2021; 23:437-442. [PMID: 34287054 DOI: 10.1089/fpsam.2020.0569] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: Rate of corrective nasal surgery after maxillomandibular advancement (MMA) for obstructive sleep apnea (OSA) has been reported to be 18.7% for functional and aesthetic indications. Objective: Describe a comprehensive strategy to optimize nasal outcomes with MMA for OSA. Methods: A retrospective review of patients undergoing MMA for OSA in a tertiary referral center was performed, with a comprehensive perioperative intervention to optimize nasal outcomes from January 2014 to February 2018. Outcomes included the Apnea-Hypopnea Index (AHI), oxygen saturation (SpO2) nadir, corrective nasal surgery needed after MMA, and Nasal Obstruction Symptom Evaluation (NOSE) scores. Results: AHI after MMA showed significant reduction (-34.65, p < 0.001), SpO2 nadir increased (+6.08, p < 0.001), and NOSE scores decreased (-5.96, p < 0.001). Corrective nasal surgery needed after MMA was reported in 6.5% (8 of 122) subjects at a mean of 8.5 months, ranging from 1 to 24.7 months. Six subjects underwent either septoplasty and/or valve stenosis repair, and two subjects underwent functional and aesthetic rhinoplasty. Conclusion: A perioperative strategy was applied since 2014 that showed effectiveness in reducing post-MMA corrective nasal surgery to 6.5%.
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Affiliation(s)
- Mohamed Abdelwahab
- Division of Sleep Surgery, Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
- Department of Otolaryngology-Head & Neck Surgery, Mansoura University Faculty of Medicine, Mansoura, Egypt
| | - Sasikarn Poomkonsarn
- Division of Sleep Surgery, Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
- Center of Excellence in Otolaryngology Head and Neck Surgery, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Xiatong Ren
- Division of Sleep Surgery, Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
- Department of Otolaryngology, Longgang District Central Hospital of Shenzhen, Shantou University Medical College, Shenzhen, China
| | - Michael Awad
- Division of Sleep Surgery, Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
- Division of Sleep Surgery, Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Chicago, Illinois, USA
| | - Robson Capasso
- Division of Sleep Surgery, Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Robert Riley
- Division of Sleep Surgery, Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Sam Most
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Stanley Yung-Chuan Liu
- Division of Sleep Surgery, Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
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Ibrahim B, de Freitas Mendonca MI, Gombar S, Callahan A, Jung K, Capasso R. Association of Systemic Diseases With Surgical Treatment for Obstructive Sleep Apnea Compared With Continuous Positive Airway Pressure. JAMA Otolaryngol Head Neck Surg 2021; 147:329-335. [PMID: 33475682 DOI: 10.1001/jamaoto.2020.5179] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance The efficacy of surgical treatments for obstructive sleep apnea (OSA) is variable when considering only the Apnea Hypopnea Index as the treatment end point. However, only a few studies have shown an association between these procedures and improved clinically relevant outcomes, such as cardiovascular, endocrine, and neurological sequelae of OSA. Objective To evaluate the association of surgery for OSA with clinically relevant outcomes. Design, Setting, and Participants This retrospective cohort study used the Truven MarketScan Database from January 1, 2007, to December 31, 2015, to identify all patients diagnosed with OSA who received a prescription of continuous positive airway pressure (CPAP), were 40 to 89 years of age, and had at least 3 years of data on file. Data were analyzed September 19, 2019. Interventions Soft tissue and skeletal surgical procedures for the treatment of OSA. Main Outcomes and Measures The occurrence of cardiovascular, neurological, and endocrine complications was compared in patients who received CPAP alone and those who received surgery. High-dimensionality propensity score matching was used to adjust the models for confounders. Kaplan-Meier survival analysis with a log-rank test was used to compare differences in survival curves. Findings A total of 54 224 patients were identified (33 405 men [61.6%]; mean [SD] age, 55.1 [9.2] years), including a cohort of 49 823 patients who received CPAP prescription alone (mean [SD] age, 55.5 [9.4] years) and 4269 patients who underwent soft tissue surgery (mean [SD] age, 50.3 [7.0] years). The median follow-up time was 4.47 (interquartile range, 3-8) years after the index CPAP prescription. In the unadjusted model, soft tissue surgery was associated with decreased cardiovascular (hazard ratio [HR], 0.92; 95% CI, 0.86-0.98), neurological (HR, 0.49; 95% CI, 0.39-0.61), and endocrine (HR, 0.80; 95% CI, 0.74-0.86) events. This finding was maintained in the adjusted model (HR for cardiovascular events, 0.91 [95% CI, 0.83-1.00]; HR for neurological events, 0.67 [95% CI, 0.51-0.89]; HR for endocrine events, 0.82 [95% CI, 0.74-0.91]). Skeletal surgery (n = 114) and concomitant skeletal and soft tissue surgery (n = 18) did not demonstrate significant differences in rates of development of systemic complications. Conclusions and Relevance In this cohort study, soft tissue surgery for OSA was associated with lower rates of development of cardiovascular, neurological, and endocrine systemic complications compared with CPAP prescription in a large convenience sample of the working insured US adult population. These findings suggest that surgery should be part of the early treatment algorithm in patients at high risk of CPAP failure or nonadherence.
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Affiliation(s)
- Badr Ibrahim
- Division of Sleep Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford Hospital and Clinics, Stanford, California
| | - Maria Isabel de Freitas Mendonca
- Division of Sleep Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford Hospital and Clinics, Stanford, California
| | - Saurabh Gombar
- Green Button, Stanford Center for Biomedical Informatics Research, Stanford, California
| | - Alison Callahan
- Green Button, Stanford Center for Biomedical Informatics Research, Stanford, California
| | - Kenneth Jung
- Green Button, Stanford Center for Biomedical Informatics Research, Stanford, California
| | - Robson Capasso
- Division of Sleep Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford Hospital and Clinics, Stanford, California
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AlSaty G, Burns M, Ngan P. Effects of maxillomandibular advancement surgery on a skeletal Class III patient with obstructive sleep apnea: A case report. APOS TRENDS IN ORTHODONTICS 2021. [DOI: 10.25259/apos_191_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
This case report describes the successful surgical treatment of a patient diagnosed with obstructive sleep apnea (OSA). A 55-year-old Caucasian male patient with a body mass index (BMI) of 25.6 kg/m2 sought treatment with a chief concern of excessive daytime sleepiness and fatigue. An initial polysomnography report showed moderate OSA with an apnea-hypopnea index (AHI) of 21.2 events/h, and Epworth Sleepiness Score (ESS) of 12/24. The patient was initially prescribed with CPAP treatment but was unable to tolerate treatment after a few months. Clinical and radiographic examination revealed a concave facial profile with maxillary retrognathism. Intraoral examination revealed generalized gingival recession, missing upper lateral incisors and lower first premolars, anterior crossbite, and maxillary transverse deficiency with bilateral posterior crossbite. The lateral cephalogram showed a narrow posterior airway space at the level of the base of the tongue. The patient was treated with maxillomandibular advancement (MMA) surgery to improve airway obstruction. Results showed balanced facial esthetic and stable occlusion with a complete resolution of the patient’s OSA and a post-operative improvement of AHI from 21.2 to 0.7 events/h and ESS from 12/24 to 3/24. The lowest oxyhemoglobin saturation during sleep was improved to 97%, and the BMI decreased from 25.6 to 25.2 kg/m2. These results suggest that MMA surgical procedure can be used as a definitive treatment for patients with maxillomandibular deficiency and OSA.
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Affiliation(s)
- Ghaddy AlSaty
- Department of Orthodontics, West Virginia University School of Dentistry, Morgantown, West Virginia, United States,
| | - Mary Burns
- Einstein Medical Center, Philadelphia, Pennsylvania, United States,
| | - Peter Ngan
- Department of Orthodontics, West Virginia University School of Dentistry, Morgantown, West Virginia, United States,
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Tandon R, Aljadeff L, Finn RA. Contemplations and Ruminations of Methodological Error. J Oral Maxillofac Surg 2020; 79:49-56. [PMID: 32966768 DOI: 10.1016/j.joms.2020.08.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/09/2020] [Accepted: 08/24/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Journal articles in our field of oral and maxillofacial surgery are rife with case studies, cohort reviews, meta-analysis, basic science studies, surgical techniques, and anatomic studies. The data found in these studies often rely on multiple measurements by which the authors draw their conclusions. Accurate measurements play a critical role in the design of the study, which in turn affects the conclusion that the author is attempting to convey. Investigators must determine and develop the processes to determine the methodological errors associated with each project to help with determining the accuracy of these measurements. The aim of this study is to highlight some of the methodological errors contained in the material and methods in oral and maxillofacial surgery studies over the calendar years of 2018 and 2019 and how best to evaluate them. MATERIALS AND METHODS The inclusion criteria involved articles that used measurements where discrepancies could exist such as clinical measurements, histological measurements, and radiological measurements. The number of specimens or subjects measured in each study was tabulated. RESULTS Over the 2-year period considered, 744 articles were published, and 116 (15.6%) of them met the inclusion criteria. Of these articles, 37 (32%) reported a methodological error, while 79 (68%) did not. In addition, 31 (84%) of the articles with a methodological error were radiographic, while only 6 (16%) were not radiographic. Among the studies that reported methodological error, there were approximately 7 different types used with no rationale given for the choice. CONCLUSIONS We believe that it is important to ensure sound methods and materials, including a stated methodological error. An attempt at standardization will help to serve to enhance and strengthen the different research studies seen in our field.
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Affiliation(s)
- Rahul Tandon
- Chief Resident, Division of Oral and Maxillofacial Surgery, Department of Surgery, University of Texas Southwestern/Parkland Memorial Hospital, Dallas, TX.
| | - Lior Aljadeff
- Resident, Division of Oral and Maxillofacial Surgery, Department of Surgery, University of Texas Southwestern/Parkland Memorial Hospital, Dallas, TX
| | - Richard A Finn
- Professor, Department of Surgery, Division of Oral and Maxillofacial Surgery, Department of Cell Biology-Anatomy, University of Texas Southwestern Medical Center; Chief, Oral and Maxillofacial, Surgery, Veterans Administration North Texas Health Care System
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Ho LI, Leung YY. Skeletal Advancement Surgery in Patients with Moderate-to-Severe Obstructive Sleep Apnea. CURRENT SLEEP MEDICINE REPORTS 2020. [DOI: 10.1007/s40675-020-00169-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Cillo JE, Dattilo DJ. Maxillomandibular Advancement for Obstructive Sleep Apnea Produces Long-Term Horizontal Advancement of the Maxilla and Mandible. J Oral Maxillofac Surg 2019; 77:2524-2528. [PMID: 31344340 DOI: 10.1016/j.joms.2019.06.176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 06/03/2019] [Accepted: 06/17/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Because limited data have been reported, the purpose of the present study was to evaluate the long-term craniofacial cephalometric skeletal changes associated with maxillomandibular advancement (MMA) for obstructive sleep apnea (OSA). MATERIALS AND METHODS We performed a retrospective cephalometric cohort study of craniofacial skeletal changes in patients who had undergone MMA for OSA. The primary predictor and outcome variables were time and the change in SNB over time, respectively. Digitized cephalometric radiographs were analyzed by an independent third-party cloud-based tracing software for 6 skeletal landmarks at 3 points-preoperatively, within 1 month postoperatively, and at the last follow-up evaluation. Post hoc stratification bidimensional analyses by gender and preoperative age and body mass index (BMI) were performed. Clinically significant results were determined as a greater than 2% change from baseline. Univariate and bivariate statistics were computed, and the statistical significance level was set at P < .05. RESULTS Thirty consecutive subjects with an even gender distribution were included in the present study. The average preoperative age, apnea hypopnea index, and BMI were 43.7 years, 59.8, and 39.3 kg/m2. The average follow-up duration was 10.7 years (range, 5.6 to 18.8). Statistically and clinically significant long-term postoperative changes were found only for SNA (+4.9° or +6.0%; P < .001) and SNB (+3.8° or +4.9%; P < .001). Stratification by gender and median preoperative age and BMI did not find any statistically or clinically significant results. CONCLUSIONS Within the limitations of the present study, MMA for OSA produced statistically and clinically significant long-term cephalometric skeletal horizontal angular advancement of the maxilla and mandible of 6 and 4.9%, respectively, independently of gender, age, or BMI.
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Affiliation(s)
- Joseph E Cillo
- Associate Professor and Program Director, Division of Oral and Maxillofacial Surgery, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA.
| | - David J Dattilo
- Associate Professor and Division Director, Division of Oral and Maxillofacial Surgery, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA
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