Skeletal surgery in sleep apnea

Management of obstructive sleep apnea by maxillomandibular advancement surgery in an edentulous patient

BACKGROUND

Maxillomandibular advancement (MMA) surgery is a surgical treatment option for treating the patients with obstructive sleep apnea (OSA). Surgical treatment of OSA by MMA surgery is a problem when it is encountered with an edentulous patient because of the intermaxillary fixation problem of the jaws. A paucity of information is available concerning MMA surgery for edentulous patients.

MATERIALS AND METHODS

In this case report, we present the preoperative planning, orthognathic surgery, and postoperative phases of a 49-year-old edentulous severe OSA (apnea hypopnea index, 81.9 event/hr) patient who underwent MMA surgery.

RESULTS

Polysomnographic examination 9 months after surgery revealed normalization of the somnographic evaluations (apnea hypopnea index, 1.3).

CONCLUSIONS

The results reported in the present case showed that the surgical treatment of OSA by MMA surgery in edentulous patients could be successfully done. Further critical evaluations of this approach for the surgical treatment of edentulous OSA patients are needed.

Maxillomandibular advancement in obstructive sleep apnea syndrome patients: a restrospective study on the sagittal cephalometric variables

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.