Maxillomandibular advancement for obstructive sleep apnea

The inverted-L ramus osteotomy versus sagittal split ramus osteotomy in maxillomandibular advancement for the treatment of obstructive sleep apnea patients: A retrospective study

This study aimed to compare the effectiveness and feasibility of inverted-L osteotomy (ILO) and sagittal split ramus osteotomy (SSRO) on obstructive sleep apnea (OSA) treatment. According to different surgery procedures, 28 OSA patients who underwent maxillomandibular advancement (MMA) were divided into 2 groups (group A: ILO, n = 9; group B: SSRO, n = 19). Polysomnography (PSG) and Epworth sleepiness scale (ESS) on T0, T1and T2 were used to evaluate the effectiveness of OSA treatments. Patients' airway structures and facial appearances were also evaluated. From T0 to T1, the mean apnea-hypopnea index (AHI,/per hour) dropped from 69.2 ± 8.4 to11.2 ± 2.4 (P < 0.01) in group A and from 54.6 ± 14.6 to 9.4 ± 5.4 (P < 0.01) in group B; LSpO2 (lowest pulse oxygen saturation, %) increased from 66.5 ± 7.7% to 88.2 ± 4.6 (P < 0.01) and from 76.6 ± 10.7%to 89.4 ± 2.4% (P < 0.01) while the mean ESS score decreased by 51% in group A and 44% in group B. Most patients (group A: 88.9%; group B: 84.3%) were satisfied with their postoperative appearance. Mild relapse was observed in both groups on T2. This study concluded that MMA containing ILO and MMA containing SSRO are both feasible and effective for selected OSA patients.

Oral Functional Behavior and Neurosensation After Adult Maxillomandibular Advancement for Obstructive Sleep Apnea in the Long-Term

PURPOSE

We evaluated and correlated the long-term subjective perioral neurosensory deficit intensity and oral functional behavior difficulty after maxillomandibular advancement (MMA) for adult obstructive sleep apnea (OSA).

PATIENTS AND METHODS

We implemented a long-term retrospective cohort study of adult subjects who had undergone MMA for OSA, with subjective assessments using 7-point visual analog scales. Adult subjects who had undergone MMA for OSA with a minimum of 5 years of follow-up data available who had agreed to participate were included in the present study. The 1-sample Wilcoxon signed rank test and Spearman correlation coefficients were used to evaluate the data. Statistical significance was set at the P < .05 level.

RESULTS

Of the 51 eligible subjects, 27 (53% response rate) were included in the present study. The mean age preoperatively was 59.8 years, with a mean follow-up of 12.7 years. Most subjects (85%) had, overall, reported the long-term subjective perioral neurosensory deficit intensity to be none to very mild (mode, 0; mean, 2.20; P < .05) and oral functional behavior to have none to very mild difficulty (mode, 0; mean, 1.6; P < .05). Statistically significant moderate to strong positive correlations between the subjective assessments of oral functional behavior and perioral neurosensory deficit intensity were found for chewing (r = 0.74), kissing (r = 0.50), eating (r = 0.80), speaking (r = 0.81), and drooling (r = 0.67).

CONCLUSIONS

Within the limitations of the present study, more than 12 years after MMA for severe OSA, most subjects (85%) had minimal to no subjective perioral neurosensory deficits and very minimal to no difficulty in the subjective assessment of oral functional behavior. Strong positive correlations between the subjective decreased perioral neurosensory deficit intensity and decreased oral function behavior difficulty suggest that the return of perioral neurosensation might contribute to the return of oral functional behavior.