1
|
Yang J, Tan ML, Ho JPTF, Rosenmöller BRAM, Jamaludin FS, van Riet TCT, de Lange J. Non-sleep related outcomes of maxillomandibular advancement, a systematic review. Sleep Med Rev 2024; 75:101917. [PMID: 38503113 DOI: 10.1016/j.smrv.2024.101917] [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: 09/27/2023] [Revised: 02/13/2024] [Accepted: 02/26/2024] [Indexed: 03/21/2024]
Abstract
Maxillomandibular advancement has been shown to be an effective treatment for obstructive sleep apnea; however, the literature focuses mainly on sleep-related parameters such as apnea-hypopnea index, respiratory disturbance index and Epworth sleepiness scale. Other factors that may be important to patients, such as esthetics, patient satisfaction, nasality, swallowing problems and so forth have been reported in the literature but have not been systematically studied. Together with an information specialist, an extensive search in Medline, Embase and Scopus yielded 1592 unique articles. Titles and abstracts were screened by two blinded reviewers. In total, 75 articles were deemed eligible for full-text screening and 38 articles were included for qualitative synthesis. The most common categories of non-sleep related outcomes found were surgical accuracy, facial esthetics, functional outcomes, quality of life, patient satisfaction, and emotional health. All categories were reported using heterogenous methods, such that meta-analysis could not be performed. There was lack of consistent methods to assess these outcomes. This work is the first to systematically review non-sleep related outcomes of maxillomandibular advancement. Despite growing interest in evaluating surgical outcomes through patient subjective experiences, this review points to the need of standardized, validated methods to report these outcomes.
Collapse
Affiliation(s)
- Joshua Yang
- Harvard School of Dental Medicine, Boston, MA, USA
| | - Misha L Tan
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centre, Location Academic Medical Center (AMC), and Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands.
| | - Jean-Pierre T F Ho
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centre, Location Academic Medical Center (AMC), and Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands; Department of Oral and Maxillofacial Surgery, Northwest Clinics, Alkmaar, the Netherlands
| | - Boudewijn R A M Rosenmöller
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centre, Location Academic Medical Center (AMC), and Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands; Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands
| | - Faridi S Jamaludin
- Information Specialist Medical Library, Amsterdam University Medical Centre, Location Academic Medical Center (AMC), Amsterdam, the Netherlands
| | - Tom C T van Riet
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centre, Location Academic Medical Center (AMC), and Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centre, Location Academic Medical Center (AMC), and Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands
| |
Collapse
|
2
|
Francisco I, Nunes C, Baptista Paula A, Marques F, Prata Ribeiro M, McEvoy M, Santos M, Oliveira C, Marto CM, Spagnuolo G, Carrilho E, Travassos R, Vale F. Patient-Reported Outcomes of Maxillomandibular Surgery for Obstructive Sleep Apnea Treatment: A Scoping Review. J Clin Med 2024; 13:1232. [PMID: 38592097 PMCID: PMC10932142 DOI: 10.3390/jcm13051232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/12/2024] [Accepted: 02/18/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: The present scoping review aims to scrutinize all existing patient-reported outcomes and assess the perspectives of obstructive sleep apnea patients after maxillomandibular surgery. (2) Methods: The review was carried out according to the extensions for scoping reviews using the PRISMA-ScR guidelines. Several databases were used to carry out the initial search. This study included randomized controlled trials, cohort studies, cross-sectional and case-control studies. The included studies considered patients with obstructive sleep apnea who were submitted to orthognathic surgery as the main subjects, and the patient's perception of quality of life, satisfaction, treatment experience and side effects were assessed. (3) Results: From 1407 examined articles, a total of 16 were included. Most of the included studies used more than one questionnaire to assess quality of life, except for five articles. The most commonly referred instruments were the Epworth Sleepiness Scale, SF-36, the Functional Outcomes of Sleep and Ottawa Sleep Apnea. The most commonly assessed outcomes were sleep quality, daytime function, facial aesthetics, dental function and emotional health. (4) Conclusions: The number of variables that can be evaluated from a patient's perspective are endless, as are the tools available to assess them. Not all of these tools, which are generally questionnaires, assess all the various outcomes, and some do not compare the pre- and post-surgical situations. Most of them are generic and lack specificity for obstructive sleep apnea.
Collapse
Affiliation(s)
- Inês Francisco
- Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.N.); (A.B.P.); (F.M.); (M.P.R.); (M.M.); (M.S.); (C.O.); (R.T.); (F.V.)
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.M.M.); (E.C.)
- Laboratory for Evidence-Based Sciences and Precision Dentistry, University of Coimbra, 3000-075 Coimbra, Portugal
- Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-075 Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), 3030-370 Coimbra, Portugal
| | - Catarina Nunes
- Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.N.); (A.B.P.); (F.M.); (M.P.R.); (M.M.); (M.S.); (C.O.); (R.T.); (F.V.)
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.M.M.); (E.C.)
- Laboratory for Evidence-Based Sciences and Precision Dentistry, University of Coimbra, 3000-075 Coimbra, Portugal
- Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-075 Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), 3030-370 Coimbra, Portugal
| | - Anabela Baptista Paula
- Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.N.); (A.B.P.); (F.M.); (M.P.R.); (M.M.); (M.S.); (C.O.); (R.T.); (F.V.)
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.M.M.); (E.C.)
- Laboratory for Evidence-Based Sciences and Precision Dentistry, University of Coimbra, 3000-075 Coimbra, Portugal
- Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-075 Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), 3030-370 Coimbra, Portugal
- Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal
| | - Filipa Marques
- Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.N.); (A.B.P.); (F.M.); (M.P.R.); (M.M.); (M.S.); (C.O.); (R.T.); (F.V.)
| | - Madalena Prata Ribeiro
- Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.N.); (A.B.P.); (F.M.); (M.P.R.); (M.M.); (M.S.); (C.O.); (R.T.); (F.V.)
| | - Mariana McEvoy
- Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.N.); (A.B.P.); (F.M.); (M.P.R.); (M.M.); (M.S.); (C.O.); (R.T.); (F.V.)
| | - Mariana Santos
- Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.N.); (A.B.P.); (F.M.); (M.P.R.); (M.M.); (M.S.); (C.O.); (R.T.); (F.V.)
| | - Catarina Oliveira
- Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.N.); (A.B.P.); (F.M.); (M.P.R.); (M.M.); (M.S.); (C.O.); (R.T.); (F.V.)
| | - Carlos Miguel Marto
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.M.M.); (E.C.)
- Laboratory for Evidence-Based Sciences and Precision Dentistry, University of Coimbra, 3000-075 Coimbra, Portugal
- Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-075 Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), 3030-370 Coimbra, Portugal
- Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal
- Institute of Experimental Pathology, Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal
| | - Gianrico Spagnuolo
- Department of Neurosciences, Reprodutive and Odontostomatological Sciences, University of Naples “Federico II”, 80138 Naples, Italy
| | - Eunice Carrilho
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.M.M.); (E.C.)
- Laboratory for Evidence-Based Sciences and Precision Dentistry, University of Coimbra, 3000-075 Coimbra, Portugal
- Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-075 Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), 3030-370 Coimbra, Portugal
- Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal
| | - Raquel Travassos
- Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.N.); (A.B.P.); (F.M.); (M.P.R.); (M.M.); (M.S.); (C.O.); (R.T.); (F.V.)
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.M.M.); (E.C.)
- Laboratory for Evidence-Based Sciences and Precision Dentistry, University of Coimbra, 3000-075 Coimbra, Portugal
- Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-075 Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), 3030-370 Coimbra, Portugal
| | - Francisco Vale
- Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.N.); (A.B.P.); (F.M.); (M.P.R.); (M.M.); (M.S.); (C.O.); (R.T.); (F.V.)
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.M.M.); (E.C.)
- Laboratory for Evidence-Based Sciences and Precision Dentistry, University of Coimbra, 3000-075 Coimbra, Portugal
- Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-075 Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), 3030-370 Coimbra, Portugal
| |
Collapse
|
3
|
Zhou N, Ho JPTF, Lobbezoo F, Aarab G, de Vries N, de Lange J. Effects of maxillomandibular advancement on respiratory function and facial aesthetics in obstructive sleep apnoea patients with versus without maxillomandibular deficiency. Int J Oral Maxillofac Surg 2023; 52:343-352. [PMID: 35999147 DOI: 10.1016/j.ijom.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/26/2022] [Accepted: 08/12/2022] [Indexed: 11/29/2022]
Abstract
The aim of this study was to compare the effects of maxillomandibular advancement (MMA) on respiratory function between obstructive sleep apnoea (OSA) patients with and without maxillomandibular deficiency, and to compare the changes in facial aesthetics after MMA between the two groups. MMA-treated patients who had both baseline and follow-up polysomnography (PSG) data and lateral cephalograms were enrolled in this retrospective study. In addition to PSG and cephalometric data, patient satisfaction with postoperative breathing and facial aesthetics, and overall satisfaction with the treatment were assessed. Twenty-one patients were classified as not having maxillomandibular deficiency (without-deficiency group) and 40 patients as having maxillomandibular deficiency (with-deficiency group). The improvements in respiratory parameters (e.g., apnoea-hypopnoea index) and patient satisfaction with postoperative breathing were comparable in the two groups (P = 0.094-0.713). The changes in facial profile measurements (e.g., nasal prominence, nasolabial angel, and lip positions relative to the true vertical line) and patient satisfaction with postoperative facial aesthetics were also comparable in the two groups (P = 0.148-0.983). In conclusion, no significant difference in the effects of MMA on respiratory function and facial aesthetics between OSA patients with and without maxillomandibular deficiency was observed.
Collapse
Affiliation(s)
- N Zhou
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC - location University of Amsterdam, University of Amsterdam, Amsterdam, the Netherlands; Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - J P T F Ho
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC - location University of Amsterdam, University of Amsterdam, Amsterdam, the Netherlands; Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Oral and Maxillofacial Surgery, Northwest Clinics, Alkmaar, the Netherlands
| | - F Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - G Aarab
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - N de Vries
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Otorhinolaryngology - Head and Neck Surgery, OLVG, Amsterdam, the Netherlands; Department of Otorhinolaryngology - Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - J de Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC - location University of Amsterdam, University of Amsterdam, Amsterdam, the Netherlands; Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
4
|
Jamal BT, Ibrahim EA. Satisfaction With Facial Aesthetic Appearance Following Maxillomandibular Advancement (MMA) for Obstructive Sleep Apnea (OSA): A Meta-Analysis. Cureus 2023; 15:e35568. [PMID: 37007354 PMCID: PMC10061353 DOI: 10.7759/cureus.35568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
PURPOSE A large cohort of patients diagnosed with obstructive sleep apnea (OSA) require surgical intervention, sometimes in the form of maxillomandibular advancement (MMA), to correct their functional disturbance. Such a surgical procedure typically results in a slight modification of the patients' facial appearance. The purpose of the current systematic review and meta-analysis was to examine the rate of satisfaction with facial aesthetics post-MMA intervention and to assess its dependability on and relationship with other patient or treatment factors. Based on the literature currently available, and to the best of our knowledge, this is the first paper to draw on the topic analytically. METHODS A search was conducted on four electronic literature databases (Pubmed, Ovid, Science Direct, and Scholar). Using referred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), our inclusion criterion covered any case with adequate reported data pertaining to the research question up to June 2021. Three evaluator groups were utilized. Satisfaction was defined as either an obvious reported increase in fondness for facial appearance or a state of indifference to the cosmetic results of the conducted changes. Dissatisfaction was defined as a clear discontent with the post-operative esthetic results. A multivariate analysis of the data was conducted, and Chi-square tests for independence were used to detect any significant associations. A meta-analysis of proportion was employed to permit for Freeman-Tukey double arcsine transformation and stabilize the variance of each study's proportion. Cochran's Q was computed, and the significance level was gauged as a function of P value. RESULTS Meta-analyses of proportion conducted for assessment of aesthetic appraisal following surgical MMA for OSA elucidated a significantly higher predilection towards aesthetic satisfaction after surgical MMA for OSA for all evaluator groups in the encompassed studies. 94.2% of patients were satisfied with their facial esthetics postoperatively. CONCLUSION The vast majority of patients that undergo MMA for the correction of OSA report satisfaction with post-surgical facial aesthetics. The subjective assessment of this parameter by physicians and laypeople portrays an equivalently significant skew toward post-surgical appearance improvement. MMA is a generally safe procedure that substantially contributes to enhancement of both overall quality of life and perceived aesthetic appeal.
Collapse
|
5
|
Trevisiol L, Bersani M, Sanna G, Nocini R, D’Agostino A. Posterior airways and orthognathic surgery: What really matters for successful long-term results? Am J Orthod Dentofacial Orthop 2022; 161:e486-e497. [DOI: 10.1016/j.ajodo.2021.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 11/01/2021] [Accepted: 11/01/2021] [Indexed: 11/01/2022]
|
6
|
Alansari RA. The role of orthodontics in management of obstructive sleep apnea. Saudi Dent J 2022; 34:194-201. [PMID: 35935723 PMCID: PMC9346943 DOI: 10.1016/j.sdentj.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 01/30/2022] [Accepted: 02/07/2022] [Indexed: 11/18/2022] Open
Abstract
Dental sleep medicine is the field of dental practice that deals with the management of sleep-related breathing disorders, which includes obstructive sleep apnea (OSA) in adults and children. Depending on the developmental age of the patient and the cause of the apnea dental treatment options may vary. For adult patients, treatment modalities may include oral appliance therapy (OAT), orthognathic surgery and surgical or miniscrew supported palatal expansion. While for children, treatment may include non-surgical maxillary expansion and orthodontic functional appliances. Many physicians and dentists are unaware of the role dentistry, particularly orthodontics, may play in the interdisciplinary management of these disorders. This review article is an attempt to compile evidence-based relevant information on the role of orthodontists/sleep dentists in the screening, diagnosis, and management of sleep apnea. Oral sleep appliance mechanisms of action, selective efficacy, and the medical physiological outcomes are discussed. The purpose of this review is to provide a comprehensive understanding of how orthodontists and sleep physicians can work in tandem to maximize the benefits and minimize the side effects while treating patients with OSA.
Collapse
|
7
|
Jamal BT. Does Maxillomandibular Advancement (MMA) For Obstructive Sleep Apnea (OSA) Negatively Affect Facial Appearance? ANNALS OF DENTAL SPECIALTY 2022. [DOI: 10.51847/rvxiqxyyxa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
8
|
Kent D, Stanley J, Aurora RN, Levine CG, Gottlieb DJ, Spann MD, Torre CA, Green K, Harrod CG. Referral of adults with obstructive sleep apnea for surgical consultation: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med 2021; 17:2507-2531. [PMID: 34351849 PMCID: PMC8726364 DOI: 10.5664/jcsm.9594] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/03/2021] [Accepted: 08/03/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION This systematic review provides supporting evidence for the accompanying clinical practice guideline on the referral of adults with obstructive sleep apnea (OSA) for surgical consultation. METHODS The American Academy of Sleep Medicine commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies that compared the use of upper airway sleep apnea surgery or bariatric surgery to no treatment as well as studies that reported on patient-important and physiologic outcomes pre- and postoperatively. Statistical analyses were performed to determine the clinical significance of using surgery to treat obstructive sleep apnea in adults. Finally, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process was used to assess the evidence for making recommendations. RESULTS The literature search resulted in 274 studies that provided data suitable for statistical analyses. The analyses demonstrated that surgery as a rescue therapy results in a clinically significant reduction in excessive sleepiness, snoring, blood pressure (BP), apnea-hypopnea index (AHI), respiratory disturbance index (RDI), and oxygen desaturation index (ODI); an increase in lowest oxygen saturation (LSAT) and sleep quality; and an improvement in quality of life in adults with OSA who are intolerant or unaccepting of positive airway pressure (PAP) therapy. The analyses demonstrated that surgery as an adjunctive therapy results in a clinically significant reduction in optimal PAP pressure and improvement in PAP adherence in adults with OSA who are intolerant or unaccepting of PAP due to side effects associated with high pressure requirements. The analyses also demonstrated that surgery as an initial treatment results in a clinically significant reduction in AHI/RDI, sleepiness, snoring, BP, and ODI and an increase in LSAT in adults with OSA and major anatomical obstruction. Analysis of bariatric surgery data showed a clinically significant reduction in BP, AHI/RDI, sleepiness, snoring, optimal PAP level, BMI, and ODI and an increase in LSAT in adults with OSA and obesity. Analyses of very limited evidence suggested that upper airway surgery does not result in a clinically significant increase in risk of serious persistent adverse events and suggested that bariatric surgery may result in a clinically significant risk of iron malabsorption that may be managed with iron supplements. The task force provided a detailed summary of the evidence along with the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations. CITATION Kent D, Stanley J, Aurora RN, et al. Referral of adults with obstructive sleep apnea for surgical consultation: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med. 2021;17(12):2507-2531.
Collapse
Affiliation(s)
- David Kent
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - R. Nisha Aurora
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | - Daniel J. Gottlieb
- VA Boston Healthcare System, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Carlos A. Torre
- University of Miami, Miller School of Medicine, Miami, Florida
| | | | | |
Collapse
|
9
|
Systematic review and updated meta-analysis of multi-level surgery for patients with OSA. Auris Nasus Larynx 2021; 49:421-430. [PMID: 34736806 DOI: 10.1016/j.anl.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/01/2021] [Accepted: 10/13/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To perform an updated systematic review for determining the surgical success rate of multilevel upper airway surgery for patients with obstructive sleep apnea/hypopnea syndrome (OSA). METHODS A systematic review was performed to identify English-language studies that evaluated the treatment of adult OSA patients with multilevel OSA surgery up to January, 2018. We used polysomnography as a metric of treatment success. Articles were only included if the surgery intervention involved at least two of the frequently involved anatomic sites: nose, oropharynx and hypopharynx. Eighty-seven studies fit the inclusion criteria and a meta-analysis was performed to determine the overall success. RESULTS The meta-analysis included 3931 subjects with a mean age of 46.1 years. The originally reported success rate in the included literature was 59.9%. A meta-analysis was performed to redefine the success rate to be consistent with the commonly agreed upon criteria - namely "a reduction in apnea/hypopnea index (AHI, /hr.) of 50% or more and an AHI of less than 20". The recalculated success rate was 60.2%. Standard meta-analytic techniques for combining p-values between studies after weighting for sample size found significant improvements in AHI, apnea index, % of rapid eye movement sleep, lowest saturation of oxygen (%), and Epworth Sleepiness Scale. CONCLUSION This study shows the significant improvement of treatment outcomes with multilevel surgery for OSA patients.
Collapse
|
10
|
González MB, Casellas JB, Fernández Mondragón MP, Nuño VC, Amezaga JA, De Carlos Villafra F. Clinical, esthetic, and quality of life outcomes after telegnathic surgery in Caucasian OSAS patients. Cranio 2020; 40:425-432. [PMID: 32448099 DOI: 10.1080/08869634.2020.1767474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To carry out both an objective and subjective assessment of the facial esthetics, clinical outcome, and quality of life evaluation in 25 OSAS patients treated with telegnathic surgery. METHODS Patients were analyzed using AHI, Legan and Burstone and airway cephalometric analysis for the objective study together with youthful and esthetic perception and SF-36 health surveys for the subjective part. RESULTS Facial convexity, nasolabial and lower face-throat angle, upper lip protrusion, and vertical height-depth ratio improved the facial and neck esthetics, while the maxillary and mandibular prognathism increased. Eighty-eight percent considered an esthetic change on their facial profile and 52% a more youthful profile. FS-36 survey (pre- 48.86 and post-surgery 71.74) and AHI (pre- 41.32 and post-surgery 7.80) scores improved significantly. DISCUSSION Results after telegnathic surgery were both esthetically and clinically satisfactory. The FS-36 survey should be considered for monitoring treatment in OSAS patients.
Collapse
Affiliation(s)
- Maite Barbero González
- Surgery and Medical-Surgical Specialties Department, Area of Orthodontics, Faculty of Medicine, University of Oviedo, Oviedo, Spain
| | - Joan Brunsó Casellas
- Cruces University Hospital Department of Maxillofacial Surgery, Barakaldo, Spain
| | | | - Valentín Cabriada Nuño
- Sleep and Ventilation Unit, Respiratory Division, Cruces University Hospital, Barakaldo, Spain
| | - Julio Alvarez Amezaga
- Cruces University Hospital Department of Maxillofacial Surgery, Barakaldo, Spain.,Stomatology I Department, Faculty of Medicine, University of the Basque Country, Leioa, Spain
| | - Felix De Carlos Villafra
- Surgery and Medical-Surgical Specialties Department, Area of Orthodontics, Faculty of Medicine, University of Oviedo, Oviedo, Spain
| |
Collapse
|
11
|
Dolan JM, Weyh AM, Gomez J, Salman SO. Commentary - "Maxillomandibular Advancement for Obstructive Sleep Apnea Is Associated with Very Long-Term Overall Sleep-Related Quality-of-Life Improvement". J Oral Maxillofac Surg 2020; 78:e1-e4. [PMID: 32229018 DOI: 10.1016/j.joms.2020.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jennifer M Dolan
- Postgraduate Year 2 Resident, Department of Oral and Maxillofacial Surgery, University of Florida-Jacksonville, Jacksonville, FL
| | - Ashleigh M Weyh
- Postgraduate Year 4 Resident, Department of Oral and Maxillofacial Surgery, University of Florida-Jacksonville, Jacksonville, FL
| | - Juliana Gomez
- Postgraduate Year 1 Resident, Department of Oral and Maxillofacial Surgery, University of Florida-Jacksonville, Jacksonville, FL
| | - Salam O Salman
- Assistant Professor and Program Director, Oral and Maxillofacial Surgery Residency Program, Department of Oral and Maxillofacial Surgery, University of Florida-Jacksonville, Jacksonville, FL.
| |
Collapse
|
12
|
Maxillomandibular Advancement for Obstructive Sleep Apnea Is Associated With Very Long-Term Overall Sleep-Related Quality-of-Life Improvement. J Oral Maxillofac Surg 2020; 78:109-117. [DOI: 10.1016/j.joms.2019.06.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 06/17/2019] [Accepted: 06/17/2019] [Indexed: 12/25/2022]
|
13
|
Chintalapudi N, Lee KC, Chuang SK, Koch A. Does Maxillomandibular Advancement Change the Lay Perception of Personality and Emotional Traits? J Oral Maxillofac Surg 2020; 78:127-132. [DOI: 10.1016/j.joms.2019.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 07/19/2019] [Accepted: 08/02/2019] [Indexed: 11/25/2022]
|
14
|
Kim CH, Loree N, Han PS, Ostby ET, Kwon DI, Inman JC. Mandibular muscle attachments in genial advancement surgery for obstructive sleep apnea. Laryngoscope 2019; 129:2424-2429. [DOI: 10.1002/lary.27660] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Cherine H. Kim
- Department of Otolaryngology–Head and Neck SurgeryLoma Linda University Medical Center Loma Linda, California
| | - Nichole Loree
- Loma Linda University School of Medicine Loma Linda, California U.S.A
| | - Peter S. Han
- Department of Otolaryngology–Head and Neck SurgeryLoma Linda University Medical Center Loma Linda, California
| | - Erin T. Ostby
- Department of Otolaryngology–Head and Neck SurgeryLoma Linda University Medical Center Loma Linda, California
| | - Daniel I. Kwon
- Department of Otolaryngology–Head and Neck SurgeryLoma Linda University Medical Center Loma Linda, California
| | - Jared C. Inman
- Department of Otolaryngology–Head and Neck SurgeryLoma Linda University Medical Center Loma Linda, California
| |
Collapse
|
15
|
Camacho M, Noller MW, Del Do M, Wei JM, Gouveia CJ, Zaghi S, Boyd SB, Guilleminault C. Long-term Results for Maxillomandibular Advancement to Treat Obstructive Sleep Apnea: A Meta-analysis. Otolaryngol Head Neck Surg 2019; 160:580-593. [DOI: 10.1177/0194599818815158] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To examine outcomes in the intermediate term (1 to <4 years), long term (4 to <8 years), and very long term (≥8 years) for maxillomandibular advancement (MMA) as treatment for obstructive sleep apnea (OSA). Data Sources The Cochrane Library, Google Scholar, Embase, Cumulative Index to Nursing and Allied Health, and PubMed/MEDLINE. Review Methods Three authors systematically reviewed the international literature through July 26, 2018. Results A total of 445 studies were screened, and 6 met criteria (120 patients). Thirty-one patients showed a reduction in apnea-hypopnea index (AHI) from a mean 48.3 events/h (95% CI, 42.1-54.5) pre-MMA to 8.4 (95% CI 5.6, 11.2) in the intermediate term. Fifty-four patients showed a reduction in AHI from a mean 65.8 events/h (95% CI, 58.8-72.8) pre-MMA to 7.7 (95% CI 5.9, 9.5) in the long term. Thirty-five showed a reduction in AHI from a mean 53.2 events/h (95% CI 45, 61.4) pre-MMA to 23.1 (95% CI 16.3, 29.9) in the very long term. Improvement in sleepiness was maintained at all follow-up periods. Lowest oxygen saturation improvement was maintained in the long term. Conclusion The current international literature shows that patients with OSA who were treated with MMA maintained improvements in AHI, sleepiness, and lowest oxygen saturation in the long term; however, the mean AHI increased to moderate OSA in the very long term. Definitive generalizations cannot be made, and additional research providing individual patient data for the intermediate term, long term, and very long term is needed.
Collapse
Affiliation(s)
- Macario Camacho
- Division of Sleep Surgery and Sleep Medicine, Department of Otolaryngology–Head and Neck Surgery, Tripler Army Medical Center, Tripler AMC, Hawaii, USA
| | - Michael W. Noller
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Michael Del Do
- Department of Otolaryngology–Head and Neck Surgery, Tripler Army Medical Center, Tripler AMC, Hawaii, USA
| | - Justin M. Wei
- Department of Otolaryngology–Head and Neck Surgery, Tripler Army Medical Center, Tripler AMC, Hawaii, USA
| | - Christopher J. Gouveia
- Department of Otolaryngology–Head and Neck Surgery, Kaiser Permanente - Santa Clara, Santa Clara, California, USA
| | - Soroush Zaghi
- UCLA Medical Center–Santa Monica, University of California–Los Angeles, Santa Monica, California, USA
| | - Scott B. Boyd
- Department of Oral and Maxillofacial Surgery, School of Medicine, Retired Faculty, Vanderbilt University, Nashville, Tennessee, USA
| | - Christian Guilleminault
- Sleep Medicine Division, Department of Psychiatry, Stanford Hospital and Clinics, Redwood City, California, USA
| |
Collapse
|
16
|
John C, Gandhi S, Sakharia A, James T. Maxillomandibular advancement is a successful treatment for obstructive sleep apnoea: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 2018; 47:1561-1571. [DOI: 10.1016/j.ijom.2018.05.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 05/05/2018] [Accepted: 05/16/2018] [Indexed: 11/27/2022]
|
17
|
Gottsauner-Wolf S, Laimer J, Bruckmoser E. Posterior Airway Changes Following Orthognathic Surgery in Obstructive Sleep Apnea. J Oral Maxillofac Surg 2018; 76:1093.e1-1093.e21. [DOI: 10.1016/j.joms.2017.11.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 11/17/2017] [Accepted: 11/22/2017] [Indexed: 12/16/2022]
|
18
|
Posnick JC, Adachie A, Singh N, Choi E. "Silent" Sleep Apnea in Dentofacial Deformities and Prevalence of Daytime Sleepiness After Orthognathic and Intranasal Surgery. J Oral Maxillofac Surg 2017; 76:833-843. [PMID: 28988100 DOI: 10.1016/j.joms.2017.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 08/17/2017] [Accepted: 09/01/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE The purposes of this study were to determine the occurrence of undiagnosed "silent" obstructive sleep apnea (OSA) in dentofacial deformity (DFD) patients at initial surgical presentation and to report on the level of daytime sleepiness in DFD patients with OSA and chronic obstructive nasal breathing (CONB) after undergoing bimaxillary, chin, and intranasal surgery. MATERIALS AND METHODS A retrospective cohort study of patients with a bimaxillary DFD and CONB was implemented. Patients were divided into those with no OSA (group I) and those with OSA (group II). Group II was further subdivided into patients referred with polysomnogram (PSG)-confirmed OSA (group IIa) and those with a diagnosis of OSA only after surgical consultation, airway evaluation, and a positive PSG (group IIb). Group II patients were analyzed at a minimum of 1 year after surgery (range, 1 to 10 years) for daytime sleepiness with the Epworth Sleepiness Scale. Patients with postoperative excessive daytime sleepiness were assessed for risk factors and continued need for OSA treatment. Patients in group II were studied to determine which DFD patterns were most associated with OSA. We compared the prevalence of OSA between our study population and the general population. RESULTS Two hundred sixty-two patients met the inclusion criteria. Of these, 23% (60 of 262) had PSG-confirmed OSA (group II). This rate was much higher than that found in the general population. Of the patients, 7% (19 of 262) were known to have OSA at initial surgical consultation (group IIa). An additional 16% (41 of 262) were later confirmed by PSG to have OSA (group IIb). Patients with primary mandibular deficiency and short face DFDs were most likely to have OSA (P < .001 and P = .001, respectively). In group II, 91% (55 of 60) rated their daytime sleepiness as "not sleepy" at a minimum of 1 year after surgery. A significant association was found between group II patients with postoperative excessive daytime sleepiness ("sleepy" or "very sleepy") and a preoperative body mass index category of overweight (P = .026). CONCLUSIONS Our study found silent OSA to be frequent in the DFD population. The prevalence of OSA in DFD patients exceeded that estimated in the general population, with retrusive jaw patterns most affected. In DFD patients also presenting with OSA and CONB, we confirmed low levels of daytime sleepiness long-term after simultaneous bimaxillary orthognathic, chin, and intranasal surgery.
Collapse
Affiliation(s)
- Jeffrey C Posnick
- Director, Posnick Center for Facial Plastic Surgery, Chevy Chase, MD; Clinical Professor of Surgery and Pediatrics, Georgetown University, Washington, DC; Clinical Professor of Orthodontics, University of Maryland School of Dentistry, Baltimore, MD; and Adjunct Professor of Oral and Maxillofacial Surgery, Howard University College of Dentistry, Washington, DC.
| | - Anayo Adachie
- Past Fellow, Posnick Center for Facial Plastic Surgery, Chevy Chase, MD
| | - Neeru Singh
- Past Fellow, Posnick Center for Facial Plastic Surgery, Chevy Chase, MD
| | - Elbert Choi
- Past Chief Resident, Department of Oral and Maxillofacial Surgery, Howard University Hospital, Washington, DC
| |
Collapse
|
19
|
Cottrell DA, Farrell B, Ferrer-Nuin L, Ratner S. Surgical Correction of Maxillofacial Skeletal Deformities. J Oral Maxillofac Surg 2017; 75:e94-e125. [DOI: 10.1016/j.joms.2017.04.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
20
|
Facial Mobility after Maxilla-Mandibular Advancement in Patients with Severe Obstructive Sleep Apnea Syndrome: A Three-Dimensional Study. Int J Dent 2017; 2017:1574304. [PMID: 28659977 PMCID: PMC5474255 DOI: 10.1155/2017/1574304] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 05/04/2017] [Accepted: 05/14/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction. The functional results of surgery in terms of facial mobility are key elements in the treatment of patients. Little is actually known about changes in facial mobility following surgical treatment with maxillomandibular advancement (MMA). Objectives. The three-dimensional (3D) methods study of basic facial movements in typical OSAS patients treated with MMA was the topic of the present research. Materials and Methods. Ten patients affected by severe obstructive sleep apnea syndrome (OSAS) were engaged for the study. Their facial surface data was acquired using a 3D laser scanner one week before (T1) and 12 months after (T2) orthognathic surgery. The facial movements were frowning, grimace, smiling, and lip purse. They were described in terms of surface and landmark displacements (mm). The mean landmark displacement was calculated for right and left sides of the face, at T1 and at T2. Results. One year after surgery, facial movements were similar to presurgical registrations. No modifications of symmetry were present. Conclusions. Despite the skeletal maxilla-mandible expansion, orthognathic surgical treatment (MMA) of OSAS patients does not seem to modify facial mobility. Only an enhancement of amplitude in smiling and knitting brows was observed. These results could have reliable medical and surgical applications.
Collapse
|
21
|
Vigneron A, Tamisier R, Orset E, Pepin JL, Bettega G. Maxillomandibular advancement for obstructive sleep apnea syndrome treatment: Long-term results. J Craniomaxillofac Surg 2017; 45:183-191. [DOI: 10.1016/j.jcms.2016.12.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 10/26/2016] [Accepted: 12/01/2016] [Indexed: 10/20/2022] Open
|
22
|
Friedman M, Duggal P, Joseph NJ. Revision uvulopalatoplasty by Z-palatoplasty. Otolaryngol Head Neck Surg 2016; 136:638-43. [PMID: 17418265 DOI: 10.1016/j.otohns.2006.03.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2005] [Accepted: 03/28/2006] [Indexed: 11/21/2022]
Abstract
Objective To study the effectiveness of Z-palatoplasty (ZPP) for patients with persistent obstructive sleep apnea/hypopnea syndrome (OSAHS) after previous uvulopharyngopalatoplasty (UP3). Setting Prospective study of 31 subjects who sought revision surgery in university-affiliated medical center. Study Design In accord with Institutional Review Board approval, 40 consenting adult patients with persistent, progressive, or recurrent OSAHS of moderate/severe severity despite previous UP3 surgeries were enrolled. All patients had preoperative subjective assessment of daytime sleepiness, quality of life, and snoring level. All patients underwent revision ZPP, radiofrequency tongue-base reduction, and often repair of nasopharyngeal stenosis. Follow-up continued for 6 months. Results Thirty-one patients completed the study. No patient demonstrated clinically significant postoperative velopharyngeal incompetence after 14 weeks. No major perioperative complications occurred. Subjective improvement was achieved in all patients, and objective cure was achieved in 21 patients (67.7%). Conclusions Z-palatoplasty is safe and effective for selected patients who have failed UP3.
Collapse
Affiliation(s)
- Michael Friedman
- Department of Otolaryngology and Bronchoesophagology, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612-3833, USA.
| | | | | |
Collapse
|
23
|
Quality of Life Assessment After Maxillomandibular Advancement Surgery for Obstructive Sleep Apnea. J Oral Maxillofac Surg 2016; 74:1228-37. [PMID: 26917205 DOI: 10.1016/j.joms.2016.01.043] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 01/13/2016] [Accepted: 01/22/2016] [Indexed: 11/21/2022]
Abstract
PURPOSE Although maxillomandibular advancement (MMA) surgery is highly efficacious for the management of obstructive sleep apnea (OSA), little information exists regarding the subjective effect of this treatment modality. The present study was undertaken to investigate the effect of MMA on patient-perceived quality of life (QOL) in OSA. PATIENTS AND METHODS A retrospective cohort study of patients treated with MMA for OSA from May 2010 to April 2015 was performed. The primary outcome measure was a change in the QOL detected using the Ottawa Sleep Apnea Questionnaire (OSA-Q), which assesses the MMA-related changes in QOL with a 5-point Likert scale. The secondary outcome measure was a change in the apnea hypopnea index (AHI). RESULTS Twenty-two patients participated in the present study. The mean maxillary and mandibular advancement were 8.36 and 11.08 mm, respectively. The AHI decreased from 42.4 to 6.9 events per hour postoperatively (P < .001). The QOL improved significantly after MMA (OSA-Q score 3.98 ± 0.35; P < 001). The sleep quality (4.35 ± 0.63), daytime function (4.13 ± 0.46), physical health (4.19 ± 0.45), mental and emotional health (4.02 ± 0.55), and sexual health (3.78 ± 0.62) categories all improved postoperatively (P < .001). The MMA-related side effects did not adversely affect the QOL. CONCLUSIONS MMA for OSA significantly improves patient's subjective overall QOL, with few MMA-related side effects.
Collapse
|
24
|
Liu SYC, Huon LK, Lo MT, Chang YC, Capasso R, Chen YJ, Shih TTF, Wang PC. Static craniofacial measurements and dynamic airway collapse patterns associated with severe obstructive sleep apnoea: a sleep MRI study. Clin Otolaryngol 2016; 41:700-706. [PMID: 26615985 DOI: 10.1111/coa.12598] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Using sleep MRI, we aimed to identify static craniofacial measurements and dynamic upper airway collapse patterns associated with severe obstructive sleep apnoea (OSA) during natural sleep in age and BMI-matched patients. DESIGN Nested case-control study. SETTING Sleep MRI images (3.0 Tesla scanner) and synchronised acoustic recording were used to observe patterns of dynamic airway collapse in subjects with mild and severe OSA. Midsagittal images were also used for static craniofacial measurements. PARTICIPANTS Fifteen male subjects with severe OSA (mean AHI 70.3 ± 23 events/h) were matched by age and BMI to 15 subjects with mild OSA (mean AHI 7.8 ± 1.4 events/h). Subjects were selected from a consecutive sleep MRI study cohort. MAIN OUTCOME MEASURES Static craniofacial measurements selected a priori included measurements that represent maxillomandibular relationships and airway morphology. Axial, sagittal and coronal views of the airway were rated for dynamic collapse at retropalatal, retroglossal and lateral pharyngeal wall regions by blinded reviewers. Bivariate analysis was used to correlate measures associated with severity of OSA using AHI. Statistical significance was set at P < 0.01. RESULTS Lateral pharyngeal wall collapse from dynamic sleep MRI (β = 51.8, P < 0.001) and upper airway length from static MRI images (β = 27.2, P < 0.001) positively correlated with severity of OSA. CONCLUSIONS Lateral pharyngeal wall collapse and upper airway length are significantly associated with severe OSA based on sleep MRI. Assessment of these markers can be readily translated to routine clinical practice, and their identification may direct targeted surgical treatment.
Collapse
Affiliation(s)
- Stanley Yung-Chuan Liu
- Division of Sleep Surgery, Department of Otolaryngology-Head & Neck Surgery, Stanford University Medical Center, Stanford, CA, USA.,School of Medicine, Stanford University, Stanford, CA, USA
| | - Leh-Kiong Huon
- School of Medicine, Stanford University, Stanford, CA, USA.,Department of Otolaryngology-Head &Neck Surgery, Cathay General Hospital, Taipei, Taiwan.,School of Medicine, Fu Jen Catholic University, Taipei, Taiwan
| | - Men-Tzung Lo
- Department of Biomedical Sciences and Engineering, National Central University, Taoyuan, Taiwan
| | - Yi-Chung Chang
- Department of Biomedical Sciences and Engineering, National Central University, Taoyuan, Taiwan
| | - Robson Capasso
- Division of Sleep Surgery, Department of Otolaryngology-Head & Neck Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - Yunn-Jy Chen
- Department of Dental Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | | | - Pa-Chun Wang
- Department of Otolaryngology-Head &Neck Surgery, Cathay General Hospital, Taipei, Taiwan.,School of Medicine, Fu Jen Catholic University, Taipei, Taiwan.,Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| |
Collapse
|
25
|
Yaremchuk KL. Historical classics: Oldies but goodies. Laryngoscope 2015; 125:1271-2. [PMID: 25946699 DOI: 10.1002/lary.25325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 03/20/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Kathleen L Yaremchuk
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
| |
Collapse
|
26
|
Camacho M, Teixeira J, Abdullatif J, Acevedo JL, Certal V, Capasso R, Powell NB. Maxillomandibular Advancement and Tracheostomy for Morbidly Obese Obstructive Sleep Apnea. Otolaryngol Head Neck Surg 2015; 152:619-30. [DOI: 10.1177/0194599814568284] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 12/23/2014] [Indexed: 11/15/2022]
Abstract
Objective The objective of this study is to systematically review polysomnography data and sleepiness in morbidly obese (body mass index [BMI] ≥40 kg/m2) patients with obstructive sleep apnea (OSA) treated with either a maxillomandibular advancement (MMA) or a tracheostomy and to evaluate the outcomes. Data Sources MEDLINE, Scopus, Web of Science, and the Cochrane Library. Review Methods A search was performed from inception through April 8, 2014, in each database. Results Six maxillomandibular advancement studies (34 patients, age 42.42 ± 9.13 years, mean BMI 44.88 ± 4.28 kg/m2) and 6 tracheostomy studies (14 patients, age 52.21 ± 10.40 years, mean BMI 47.93 ± 7.55 kg/m2) reported individual patient data. The pre- and post-MMA means ± SDs for apnea-hypopnea indices were 86.18 ± 33.25/h and 9.16 ± 7.89/h ( P < .00001), and lowest oxygen saturations were 66.58% ± 16.41% and 87.03% ± 5.90% ( P < .00001), respectively. Sleepiness following MMA decreased in all 5 patients for whom it was reported. The pre- and posttracheostomy mean ± SD values for apnea indices were 64.43 ± 41.35/h and 1.73 ± 2.68/h ( P = .0086), oxygen desaturation indices were 69.20 ± 26.10/h and 41.38 ± 36.28/h ( P = .22), and lowest oxygen saturations were 55.17% ± 16.46% and 79.83% ± 4.36% ( P = .011), respectively. Two studies reported outcomes for Epworth Sleepiness Scale for 5 patients, with mean ± SD values of 18.80 ± 4.02 before tracheostomy and 2.80 ± 2.77 after tracheostomy ( P = .0034). Conclusion Data for MMA and tracheostomy as treatment for morbidly obese, adult OSA patients are significantly limited. We caution surgeons about drawing definitive conclusions from these limited studies; higher level studies are needed.
Collapse
Affiliation(s)
- Macario Camacho
- Sleep Medicine Division, Stanford Hospital and Clinics, Redwood City, California, USA
| | - Jeffrey Teixeira
- US Army, Department of Otolaryngology–Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Jose Abdullatif
- Department of Otorhinolaryngology, Hospital Bernardino Rivadavia, Buenos Aires, Argentina
| | - Jason L. Acevedo
- US Army, Department of Otolaryngology–Head and Neck Surgery, Reynolds Army Community Hospital, Fort Sill, Oklahoma, USA
| | - Victor Certal
- Department of Otorhinolaryngology/Sleep Medicine Centre–Hospital CUF, Porto, Portugal
- CINTESIS–Centre for Research in Health Technologies and Information Systems, University of Porto, Porto, Portugal
| | - Robson Capasso
- Department of Otolaryngology–Head and Neck Surgery, Sleep Surgery Division, Stanford University Medical Center, Stanford, California, USA
| | - Nelson B. Powell
- Department of Otolaryngology–Head and Neck Surgery, Sleep Surgery Division, Stanford Hospital and Clinics, Stanford, California, USA
| |
Collapse
|
27
|
OSAS surgery and postoperative discomfort: phase I surgery versus phase II surgery. BIOMED RESEARCH INTERNATIONAL 2015; 2015:439847. [PMID: 25695081 PMCID: PMC4324478 DOI: 10.1155/2015/439847] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 07/16/2014] [Accepted: 10/23/2014] [Indexed: 11/17/2022]
Abstract
Introduction. This study aims to investigate the reasons that discourage the patients affected by OSAS to undergo orthognathic surgery and compares the postoperative discomfort of phase I (soft tissue surgery) and phase II (orthognathic surgery) procedures for treatment of OSAS. Material and Methods. A pool of 46 patients affected by OSAS was divided into two groups: “surgery patients” who accepted surgical treatments of their condition and “no surgery patients” who refused surgical procedures. The “surgery patients” group was further subdivided into two arms: patients who accepted phase I procedures (IP) and those who accepted phase II (IIP). To better understand the motivations behind the refusal of II phase procedures, we asked the patients belonging to both the IP group and “no surgery” group to indicate the main reason that influenced their decision to avoid II phase procedures. We also monitored and compared five parameters of postoperative discomfort: pain, painkiller assumption, length of hospitalization, foreign body sensation, and diet assumption following IP and IIP procedures. Results. The main reason to avoid IIP procedures was the concern of a more severe postoperative discomfort. Comparison of the postoperative discomfort following IP versus IIP procedures showed that the former scored worse in 4 out of 5 parameters analyzed. Conclusion. IIP procedures produce less postoperative discomfort. IIP procedures, namely, orthognathic surgery, should be the first choice intervention in patients affected by OSAS and dentoskeletal malformation.
Collapse
|
28
|
Islam S, Uwadiae N, Ormiston IW. Orthognathic surgery in the management of obstructive sleep apnoea: experience from maxillofacial surgery unit in the United Kingdom. Br J Oral Maxillofac Surg 2014; 52:496-500. [PMID: 24793413 DOI: 10.1016/j.bjoms.2014.04.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 04/02/2014] [Indexed: 10/25/2022]
Abstract
In the United Kingdom, maxillofacial techniques are underused in the treatment of obstructive sleep apnoea (OSA). We retrospectively analysed the details and relevant clinical data of consecutive patients who had operations for OSA at the maxillofacial unit in Leicester between 2002 and 2012. They had been referred from the local sleep clinic after investigation and diagnosis, and in all cases treatment with continuous positive airway pressure (CPAP) had failed. We compared preoperative and postoperative apnoea/hypopnoea indices (AHI), scores for the Epworth sleepiness scale (ESS), and lowest oxygen saturation to measure surgical success (AHI of less than 15 and a 50% reduction in the number of apnoeas or hypopnoea/hour) and surgical cure (AHI of less than 5). We identified 51 patients (mean age 44 years, range 21-60) with a mean (SD) body mass index (BMI) of 29 (3.4). Most patients had bimaxillary advancement with genioplasty (n=42). Differences in mean (SD) preoperative and postoperative values were significant for all 3 outcome measures (AHI: 42 (17) to 8 (7) p<0.001; ESS: 14 (4) to 5 (4) p<0.001; lowest oxygen saturation: 76% (11%) to 83% (7%); p=0.006). On the postoperative sleep study 85% of patients met the criteria for surgical success. Our experience has confirmed that bimaxillary advancement results in a high rate of success in patients with OSA. The operation has a role in the management of selected patients in the UK who do not adhere to CPAP.
Collapse
Affiliation(s)
- Shofiq Islam
- Department of Maxillofacial Surgery, Leicester Royal Infirmary, Infirmary Square, Leicester, East Midlands LE1 5WW, UK.
| | - Nosa Uwadiae
- Department of Maxillofacial Surgery, Leicester Royal Infirmary, Infirmary Square, Leicester, East Midlands LE1 5WW, UK
| | - Ian W Ormiston
- Department of Maxillofacial Surgery, Leicester Royal Infirmary, Infirmary Square, Leicester, East Midlands LE1 5WW, UK
| |
Collapse
|
29
|
Genioglossus muscle advancement: A modification of the conventional technique. J Craniomaxillofac Surg 2014; 42:239-44. [DOI: 10.1016/j.jcms.2013.05.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 05/09/2013] [Accepted: 05/10/2013] [Indexed: 11/17/2022] Open
|
30
|
Gerbino G, Bianchi FA, Verzé L, Ramieri G. Soft tissue changes after maxillo-mandibular advancement in OSAS patients: A three-dimensional study. J Craniomaxillofac Surg 2014; 42:66-72. [DOI: 10.1016/j.jcms.2013.02.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 02/19/2013] [Accepted: 02/19/2013] [Indexed: 11/25/2022] Open
|
31
|
Hsieh YJ, Liao YF. Effects of maxillomandibular advancement on the upper airway and surrounding structures in patients with obstructive sleep apnoea: a systematic review. Br J Oral Maxillofac Surg 2013; 51:834-40. [DOI: 10.1016/j.bjoms.2012.11.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 11/18/2012] [Indexed: 11/26/2022]
|
32
|
Ronchi P, Cinquini V, Ambrosoli A, Caprioglio A. Maxillomandibular advancement in obstructive sleep apnea syndrome patients: a restrospective study on the sagittal cephalometric variables. J Oral Maxillofac Res 2013; 4:e5. [PMID: 24422033 PMCID: PMC3886110 DOI: 10.5037/jomr.2013.4205] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 06/29/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The present retrospective study analyzes sagittal cephalometric changes in patients affected by obstructive sleep apnea syndrome submitted to maxillomandubular advancement. MATERIAL AND METHODS 15 adult sleep apnea syndrome (OSAS) patients diagnosed by polysomnography (PSG) and treated with maxillomandubular advancement (MMA) were included in this study. Pre- (T1) and postsurgical (T2) PSG studies assessing the apnea/hypopnea index (AHI) and the lowest oxygen saturation (LSAT) level were compared. Lateral cephalometric radiographs at T1 and T2 measuring sagittal cephalometric variables (SNA, SNB, and ANB) were analyzed, as were the amount of maxillary and mandibular advancement (Co-A and Co-Pog), the distance from the mandibular plane to the most anterior point of the hyoid bone (Mp-H), and the posterior airway space (PAS). RESULTS Postoperatively, the overall mean AHI dropped from 58.7 ± 16 to 8.1 ± 7.8 events per hour (P < 0.001). The mean preoperative LSAT increased from 71% preoperatively to 90% after surgery (P < 0.001). All the patients in our study were successfully treated (AHI < 20 or reduced by 50%). Cephalometric analysis performed after surgery showed a statistically significant correlation between the mean SNA variation and the decrease in the AHI (P = 0.01). The overall mean SNA increase was 6°. CONCLUSIONS Our findings suggest that the improvement observed in the respiratory symptoms, namely the apnea/hypopnea episodes, is correlated with the SNA increase after surgery. This finding may help maxillofacial surgeons to establish selective criteria for the surgical approach to sleep apnea syndrome patients.
Collapse
Affiliation(s)
- Paolo Ronchi
- Maxillofacial Surgery Unit, Sant'Anna Hospital Como Italy
| | - Valentina Cinquini
- Department of Orthodontics, School of Dentistry, University of Insubria, Varese Italy
| | - Alessandro Ambrosoli
- Department of Orthodontics, School of Dentistry, University of Insubria, Varese Italy
| | - Alberto Caprioglio
- Department of Orthodontics, School of Dentistry, University of Insubria, Varese Italy
| |
Collapse
|
33
|
Cohen-Levy J, Petelle B, Vieille E, Dumitrache M, Fleury B. Évolution du profil facial après chirurgie d’avancée maxillomandibulaire dans le traitement du syndrome d’apnées obstructives du sommeil. Int Orthod 2013. [DOI: 10.1016/j.ortho.2012.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
34
|
Changes in facial profile after maxillomandibular advancement surgery for obstructive sleep apnea syndrome. Int Orthod 2013; 11:71-92. [PMID: 23402956 DOI: 10.1016/j.ortho.2012.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
UNLABELLED The aim of this study was to assess changes in the profile of adult male patients treated for obstructive sleep apnea syndrome (OSAS) with maxillomandibular advancement (MMA) surgery and to measure patient perception of changes compared with that of different panels. MATERIALS AND METHODS Fifteen consecutive apneic patients displaying a wide variety of morphological types, mean age 42 years (20-59), a BMI of 26.60 kg/m(2) (22-29), a mean initial Apnea Hypopnea Index (AHI) of 50.9 (19-85), underwent MMA. Assessment was done by facial photography, lateral cephalographs (Tweed analysis modified by Riley and Delaire architectural analysis), polysomnographic records and a validated self-assessment questionnaire. Patients' pre- and postoperative profiles were taken from photographs using Photoshop 7™ software. Their darkened outlines were shown randomly in positions A or B (pre- and postoperative) to panels composed of orthodontists (n=40), fine arts students (n=50) and lay persons (n=50) who were requested to choose the most attractive profiles. RESULTS The MMA success rate for OSAS was 80% (12/15) for an AHI less than 15, with no surgical complications. All patients reported a reduction of their symptoms and 14 out of 15 were satisfied with the esthetic outcome. Mean advancement was 8.4mm (3.0-10.0) for the maxilla and 10.8mm (10.0-13.0) for the mandible. Following MMA, 12 out of 15 exhibited maxillary protrusion and six out of 15 mandibular protrusion. The mean change in the nasolabial angle was -5.7° (-27°; 14°). The postoperative profiles were preferred by 85% of the combined panels (P=<0.001), showing no significant difference from one panel to another. No skeletal characteristic could be correlated with the esthetic preference. Upper lip retrusion, open nasolabial angle and dolichofacial type emerged as positive preoperative predictors of esthetic preference. CONCLUSION The profile changes following MMA were favorably perceived in the majority of cases. However, specific orthodontic preparation could be offered to patients with pronounced preoperative protrusion.
Collapse
|
35
|
Cottrell DA, Edwards SP, Gotcher JE. Surgical correction of maxillofacial skeletal deformities. J Oral Maxillofac Surg 2013; 70:e107-36. [PMID: 23127998 DOI: 10.1016/j.joms.2012.07.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
36
|
Vezina JP, Blumen M, Buchet I, Chabolle F. Sleep-Disordered Breathing: Choosing the Right Cephalometric Analysis. J Oral Maxillofac Surg 2012; 70:1442-8. [DOI: 10.1016/j.joms.2011.03.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 03/21/2011] [Accepted: 03/22/2011] [Indexed: 11/25/2022]
|
37
|
Liu SR, Yi HL, Guan J, Chen B, Wu HM, Yin SK. Changes in facial appearance after maxillomandibular advancement for severe obstructive sleep apnoea hypopnoea syndrome in Chinese patients: a subjective and objective evaluation. Int J Oral Maxillofac Surg 2012; 41:1112-9. [PMID: 22503563 DOI: 10.1016/j.ijom.2012.03.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 01/07/2012] [Accepted: 03/12/2012] [Indexed: 11/20/2022]
Abstract
This study evaluates the outcome and change in facial appearance after maxillomandibular advancement (MMA) in Chinese adults with severe obstructive sleep apnoea hypopnoea syndrome (OSAHS). Twelve patients underwent MMA with adjunctive procedures for severe OSAHS. All underwent physical examination, Epworth Sleepiness Scale evaluation, cephalometry, polysomnography, and facial photographic assessment before and 6 months after MMA. The aesthetic plane (relationship of nose, lips, and chin) was used to judge soft tissue facial profile change after MMA. Postoperative cephalometric data were compared with normal occlusive standards and aesthetic norms. Pre- and postoperative aesthetic appearance was evaluated by 100 lay people using a 10-point visual analogue scale. The maxillomandibular complex (MMC) was advanced 5-10 mm (mean 7.4 mm). The success rate was 83%. All patients were satisfied with the functional and aesthetic results. Postoperative SNA, SNB, and posterior airway space increased and mandibular plane-to-hyoid distance decreased significantly in all patients. The lower lip was closer to EP than the preoperative and normal occlusive standard. In 11 of 12 patients, the lay aesthetic scores were significantly higher postoperatively. MMA is effective for Chinese adults with severe OSAHS. In most patients, facial appearance was more attractive after MMC advancement of 5-10 mm.
Collapse
Affiliation(s)
- S-r Liu
- Department of Otorhinolaryngology, Affiliated Sixth People's Hospital of Shanghai Jiao tong University, Shanghai, China
| | | | | | | | | | | |
Collapse
|
38
|
Prinsell JR. Primary and secondary telegnathic maxillomandibular advancement, with or without adjunctive procedures, for obstructive sleep apnea in adults: a literature review and treatment recommendations. J Oral Maxillofac Surg 2011; 70:1659-77. [PMID: 21855196 DOI: 10.1016/j.joms.2011.03.064] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Revised: 03/04/2011] [Accepted: 03/28/2011] [Indexed: 10/17/2022]
Abstract
PURPOSE To further define the role, surgical principles, and therapeutic efficacy of primary and secondary maxillomandibular advancement (MMA), with and without intrapharyngeal or extrapharyngeal adjunctive procedures, for obstructive sleep apnea in adults. MATERIALS AND METHODS A review of the literature, using mean percent reduction in apnea hypopnea index as the primary outcome measure of therapeutic efficacy for standardized comparison. Other occasionally reported MMA outcome parameters were sleep staging variables, lowest oxyhemoglobin saturation levels, Epworth scores, blood pressure changes, lateral cephalometric data, and complications. RESULTS Mean percent reduction in apnea hypopnea index was 92.1% for primary MMA with extrapharyngeal procedures, 88.4% for primary MMA, 86.6% for secondary MMA, 79.4% for primary MMA with intrapharyngeal procedures, 53.0% for non-MMA multilevel surgery, 31.3% for uvulopalatopharyngoplasty, and 89.8% for nasal continuous positive airway pressure. Treatment recommendations for telegnathic MMA included surgical goals and guidelines, indications and staging protocols, surgical principles and techniques, and postoperative airway management. CONCLUSIONS Primary and secondary MMA are highly therapeutic, and extrapharyngeal are more therapeutic than intrapharyngeal procedures when performed concomitantly with primary MMA. However, long-term success of obstructive sleep apnea treatment should be measured by a yet undefined comprehensive algorithm of standardized multiple weighted outcome parameters.
Collapse
|
39
|
Sears CR, Miller AJ, Chang MK, Huang JC, Lee JS. Comparison of pharyngeal airway changes on plain radiography and cone-beam computed tomography after orthognathic surgery. J Oral Maxillofac Surg 2011; 69:e385-94. [PMID: 21778015 DOI: 10.1016/j.joms.2011.03.015] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 03/09/2011] [Accepted: 03/10/2011] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of the present prospective study was to develop a 3-dimensional analysis of the airway using cone-beam computed tomography (CBCT) and to determine whether changes in the airway before and after orthognathic surgery correlate on 2-dimensional lateral cephalogram and 3-dimensional CBCT images. MATERIALS AND METHODS Patients requiring orthognathic surgery during 2004 to 2005 were recruited for the present study. Lateral cephalograms and CBCT scans were obtained at 3 points: preoperatively, within 1 month postoperatively, and after 6 months postoperatively. The nasopharynx, oropharynx, and hypopharynx were segmented on both the radiograph and the CBCT scan for each patient in a repeatable manner at each point. For the lateral cephalogram, linear measurements in the middle of each of the 3 segments were obtained. For the CBCT, volumetric measurements of each of the 3 segments were obtained. The intrarater variability was assessed, and Pearson's correlation was used to compare the 2 imaging modalities. RESULTS A total of 20 patients scheduled for orthognathic surgery were recruited for the present study. Of the 20 patients, 13 were female and 7 were male. The mean age at surgery was 23.85 years (range 14 to 43). Of the 20 patients, 6 underwent maxillary advancement only, 8 underwent mandibular advancement with or without genioplasty, and 6 underwent 2-jaw surgery or mandibular setback. We examined the entire cohort without separation into procedure or examination point and found a weak, but statistically significant, correlation between the linear and volume measurements in the nasopharyngeal and oropharyngeal regions but not in the hypopharyngeal region (r = 0.43, P < .002; r = 0.49, P < .0002; r = 0.16, P = .26, respectively). The maxillary advancement group (n = 6) demonstrated a correlation between the linear and volume measurements in the nasopharyngeal region (r = 0.53, P = .03). The mandibular advancement with or without genioplasty group (n = 8) showed a correlation in the nasopharyngeal and oropharyngeal regions (r = 0.55, P < .02, and r = 0.46, P = .05, respectively). For the combination/setback procedures (n = 6), a correlation was found in the oropharyngeal region (r = 0.64, P < .01). All other comparisons between the linear and volume measurements did not correlate. Additionally, no correlations were found between the linear and volumetric change in airway size between 6 months postoperatively and preoperatively, except for the oropharyngeal region (r = 0.67, P < .01). CONCLUSION We present a method of measuring the airway that could be used for both 2-dimensional and 3-dimensional images. It includes segmentation of the pharyngeal airway into its nasopharyngeal, oropharyngeal, and hypopharyngeal components. Correlations were found between the linear and volumetric measurements of the segmented airway in patients who had undergone orthognathic surgery; however, the correlations were generally weak.
Collapse
Affiliation(s)
- Chad R Sears
- Department of Orofacial Sciences, Division of Orthodontics, University of California, San Francisco, School of Medicine, San Francisco, CA 94143-0440, USA
| | | | | | | | | |
Collapse
|
40
|
Pirklbauer K, Russmueller G, Stiebellehner L, Nell C, Sinko K, Millesi G, Klug C. Maxillomandibular Advancement for Treatment of Obstructive Sleep Apnea Syndrome: A Systematic Review. J Oral Maxillofac Surg 2011; 69:e165-76. [DOI: 10.1016/j.joms.2011.01.038] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 01/27/2011] [Accepted: 01/28/2011] [Indexed: 11/28/2022]
|
41
|
Maxillomandibular Advancement for Obstructive Sleep Apnea. J Oral Maxillofac Surg 2011; 69:687-94. [DOI: 10.1016/j.joms.2010.09.014] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2010] [Accepted: 09/22/2010] [Indexed: 11/22/2022]
|
42
|
Della Marca G, Scarano E, Leoni C, Dittoni S, Losurdo A, Testani E, Colicchio S, Gnoni V, Vollono C, Zampino G. Pycnodysostosis with extreme sleep apnea: a possible alternative to tracheotomy. Sleep Breath 2011; 16:5-10. [DOI: 10.1007/s11325-010-0479-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Revised: 12/31/2010] [Accepted: 12/31/2010] [Indexed: 10/18/2022]
|
43
|
Caples SM, Rowley JA, Prinsell JR, Pallanch JF, Elamin MB, Katz SG, Harwick JD. Surgical modifications of the upper airway for obstructive sleep apnea in adults: a systematic review and meta-analysis. Sleep 2010; 33:1396-407. [PMID: 21061863 PMCID: PMC2941427 DOI: 10.1093/sleep/33.10.1396] [Citation(s) in RCA: 308] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A substantial portion of patients with obstructive sleep apnea (OSA) seek alternatives to positive airway pressure (PAP), the usual first-line treatment for the disorder. One option is upper airway surgery. As an adjunct to the American Academy of Sleep Medicine (AASM) Standards of Practice paper, we conducted a systematic review and meta-analysis of literature reporting outcomes following various upper airway surgeries for the treatment of OSA in adults, including maxillomandibular advancement (MMA), pharyngeal surgeries such as uvulopharyngopalatoplasty (UPPP), laser assisted uvulopalatoplasty (LAUP), and radiofrequency ablation (RFA), as well as multi-level and multi-phased procedures. We found that the published literature is comprised primarily of case series, with few controlled trials and varying approaches to pre-operative evaluation and post-operative follow-up. We include surgical morbidity and adverse events where reported but these were not systematically analyzed. Utilizing the ratio of means method, we used the change in the apnea-hypopnea index (AHI) as the primary measure of efficacy. Substantial and consistent reductions in the AHI were observed following MMA; adverse events were uncommonly reported. Outcomes following pharyngeal surgeries were less consistent; adverse events were reported more commonly. Papers describing positive outcomes associated with newer pharyngeal techniques and multi-level procedures performed in small samples of patients appear promising. Further research is needed to better clarify patient selection, as well as efficacy and safety of upper airway surgery in those with OSA.
Collapse
Affiliation(s)
- Sean M Caples
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester MN, USA
| | | | | | | | | | | | | |
Collapse
|
44
|
Holty JEC, Guilleminault C. Maxillomandibular advancement for the treatment of obstructive sleep apnea: A systematic review and meta-analysis. Sleep Med Rev 2010; 14:287-97. [DOI: 10.1016/j.smrv.2009.11.003] [Citation(s) in RCA: 314] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Revised: 11/09/2009] [Accepted: 11/10/2009] [Indexed: 11/16/2022]
|
45
|
Abstract
Obstructive sleep apnea (OSA) is a prevalent condition characterized by repetitive airway obstruction during sleep with associated increased morbidity and mortality. Although CPAP is the preferred treatment, poor compliance is common. Patients intolerant of conventional OSA medical treatment may benefit from surgical therapy to alleviate pharyngeal obstruction. Case series suggest that maxillomandibular advancement has the highest surgical efficacy (86%) and cure rate (43%). Soft palate surgical techniques are less successful, with uvulopalatopharyngoplasty having an OSA surgical success rate of 50% and cure rate of 16%. Further research is needed to more thoroughly assess clinical outcomes (eg, quality of life, morbidity), better identify key preoperative patient and clinical characteristics that predict success, and confirm long-term effectiveness of surgical modalities to treat OSA.
Collapse
|
46
|
Randerath WJ. Alternatives to positive airway pressure for obstructive sleep apnea syndrome. Expert Rev Respir Med 2010; 3:255-63. [PMID: 20477320 DOI: 10.1586/ers.09.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Owing to the prevalence, the considerable risk of accidents and cardiovascular consequences, optimal treatment of obstructive sleep apnea syndrome is of crucial importance. However, many patients look for alternative conservative or surgical therapies to continuous positive airway pressure to avoid discomfort and local side-effects owing to the mask. Scientific data are lacking for most of the alternative methods. However, it has been proven that intra-oral appliances can reduce mild-to-moderate respiratory disturbances; the maxillo-mandibular osteotomy is efficient in the short- and long-term but is preferred in special situations such as craniofacial dysmorphias. Weight reduction and body positioning cannot be recommended as a single treatment for obstructive sleep apnea syndrome. Resections of muscular tissue within the soft palate have to be strictly avoided. Efficacy of gentle soft palate procedures is difficult to predict and often decreases in the years following this treatment. Multilevel surgery concepts are of increasing interest, although more data from prospective, controlled studies are needed.
Collapse
Affiliation(s)
- Winfried J Randerath
- Professor of Medicine, Institute of Pneumology at the University Witten/Herdecke, Clinic for Pneumology & Allergology, Center of Sleep Medicine & Respiratory Care, Bethanien Hospital, Aufderhöherstrasse 169-175, 42699 Solingen, Germany.
| |
Collapse
|
47
|
Abstract
The current guideline discusses conservative and surgical therapy of obstructive sleep apnea (OSA) in adults from the perspective of the ear, nose and throat specialist. The revised guideline was commissioned by the German Society of Ear-Nose-Throat, Head-Neck Surgery (DG HNO KHC) and compiled by the DG HNO KHC's Working Group on Sleep Medicine. The guideline was based on a formal consensus procedure according to the guidelines set out by the German Association of Scientific Medical Societies (AWMF) in the form of a"S2e guideline". Research of the literature available on the subject up to and including December 2008 forms the basis for the recommendations. Evaluation of the publications found was made according to the recommendations of the Oxford Centre for Evidence-Based Medicine (OCEBM). This yielded a recommendation grade, whereby grade A represents highly evidence-based studies and grade D those with a low evidence base.
Collapse
|
48
|
Blumen MB, Buchet I, Meulien P, Hausser Hauw C, Neveu H, Chabolle F. Complications/adverse effects of maxillomandibular advancement for the treatment of OSA in regard to outcome. Otolaryngol Head Neck Surg 2009; 141:591-7. [DOI: 10.1016/j.otohns.2009.08.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Revised: 06/26/2009] [Accepted: 08/24/2009] [Indexed: 10/20/2022]
Abstract
Objective: To evaluate adverse effects/postoperative complications and surgical response rate of maxillomandibular advancement for the treatment of severe obstructive sleep apnea syndrome. Study Design: Case series with chart review. Setting: Otolaryngology Head and Neck Surgery Department in a teaching hospital. Subjects and Methods: A total of 59 consecutive severe sleep apnea patients underwent maxillomandibular advancement. Systemic complications were evaluated from medical charts. Functional adverse effects and cosmetic consequences were evaluated by questionnaires. The treatment outcome was assessed by polysomnography. Results: Fifty patients were evaluated. They had a mean age of 46.4 ± 9.0 years. No serious postoperative complication was observed. The most frequent local complication was mental nerve sensory loss. Most patients reported cosmetic changes. The mean apnea-hypopnea index decreased from 65.5 ± 26.7 per hour to 14.4 ± 14.5 per hour ( P < 0.0001). Light-sleep stages were also decreased ( P < 0.0001), whereas deep-sleep stages were increased ( P < 0.001). Conclusion: Maxillomandibular advancement can induce local adverse effects and cosmetic changes, but they seem to be considered as secondary to the patients according to the surgical outcome.
Collapse
Affiliation(s)
- Marc B. Blumen
- ENT Head and Neck Surgery, Foch Hospital, Suresnes, France
| | - Isabelle Buchet
- Oral and Maxillofacial Surgery, Foch Hospital, Suresnes, France
| | - Pierre Meulien
- Oral and Maxillofacial Surgery, Foch Hospital, Suresnes, France
| | | | - Helene Neveu
- Pulmonary Department, Foch Hospital, Suresnes, France
| | | |
Collapse
|
49
|
Contemporary surgery for obstructive sleep apnea syndrome. Clin Exp Otorhinolaryngol 2009; 2:107-14. [PMID: 19784401 PMCID: PMC2751873 DOI: 10.3342/ceo.2009.2.3.107] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2009] [Accepted: 08/16/2009] [Indexed: 11/08/2022] Open
Abstract
Surgical treatment of obstructive sleep apnea syndrome (OSAS) has been available in some form for greater than three decades. Early management for airway obstruction during sleep relied on tracheotomy which although life saving was not well accepted by patients. In the early eighties two new forms of treatment for OSAS were developed. Surgically a technique described as a uvulopalatopharyngoplasty (UPPP) was used to treat the retropalatal region for snoring and sleep apnea. Concurrently sleep medicine developed a nasal continuous positive airway pressure (CPAP) device to manage nocturnal airway obstruction. Both of these measures were used to expand and stabilize the pharyngeal airway space during sleep. The goal for each technique was to limit or alleviate OSAS. Almost 30 yr later these two treatment modalities continue to be the mainstay of contemporary treatment. As expected, CPAP device technology improved over time along with durable goods. Surgery followed suit and additional techniques were developed to treat soft and bony structures of the entire upper airway (nose, palate and tongue base). This review will only focus on the contemporary surgical methods that have demonstrated relatively consistent positive clinical outcomes. Not all surgical and medical treatment modalities are successful or even partially successful for every patient. Advances in the treatment of OSAS are hindered by the fact that the primary etiology is still unknown. However, both medicine and surgery continue to improve diagnostic and treatment methods. Methods of diagnosis as well as treatment regimens should always include both medical and surgical collaborations so the health and quality of life of our patients can best be served.
Collapse
|
50
|
|