Facial esthetics and subjective impairment assessed after maxillomandibular advancement surgery for patients with obstructive sleep apnea

OBJECTIVE

To assess facial esthetics and quality of life (QoL) as measure of success or failure after maxillomandibular advancement (MMA) surgery for obstructive sleep apnea (OSA).

METHODS

Visual analog scales (VAS) on facial esthetics and QoL survey, including EQ-5D3L, Epworth Sleepiness Scale (ESS), and Functional Outcome of Sleep Questionnaire (FOSQ) were collected. Outcomes were analyzed for surgical-success/failure after MMA.

RESULTS

Forty-one patients returned completed surveys (response: 66%). Mean VAS on facial esthetics was 57 ± 22 mm preoperative and 51 ± 24 mm postoperative (p = 0.217). When MMA was considered a surgical-failure, VAS was significantly more negative (40 ± 22 mm; p = 0.026). EQ-5D-3L showed an overall mean score of 73.2 ± 15.7, ESS was 6.3 ± 5.4, and FOSQ was 16.0 ± 3.3.

CONCLUSION

No significant alteration of facial esthetics were reported after MMA; however, lower QoL was associated with surgical-failure; whereas, in surgical-success, QoL were higher.

Impact of counterclockwise rotation of the occlusal plane on the mandibular advancement, pharynx morphology, and polysomnography results in maxillomandibular advancement surgery for the treatment of obstructive sleep apnea patients

PURPOSE

Evaluate the impact of counterclockwise rotation of the occlusal plane (CCWROP) on pharynx morphology and polysomnography in maxillomandibular advancement (MMA) surgery to treat obstructive sleep apnea (OSA) patients.

METHODS

Prospective clinical trial of patients with OSA treated by MMA. Computed tomography and polysomnography were performed pre- and postoperatively and the parameters were compared. The surgery classified the patients into two groups: with (R) and without (NR) CCWROP.

RESULTS

The study sample comprised 38 individuals: R (n = 19) and NR (n = 19). An anterior mandible advancement of 0.71 mm was identified for each degree of CCWROP (p < 0.001). As for polysomnography, the apnea-hypopnea index was reduced by 80% and 62% in R and NR, showing final values of 6.8 and 13.0, respectively. The apnea index changed equally in both groups. Reduction of 68 and 26% in the hypopnea index was observed for R and NR, respectively, with no statistically significant difference. Total volume increased by 45% in R and 30% in NR. Retropalatal and retrolingual volumes increased by 49% and 4% in R and 43% and 15% in NR, respectively. The minimum axial area increased by 92% in the retropalatal region and 97% in the retrolingual region in R, whereas these increases were of 76% and 31% in NR, respectively.

CONCLUSION

Anterior mandibular advancement of 0.71 mm for each degree of CCWROP is of great importance for surgical planning. As a result of this resource, individuals in R presented better results than those in NR in all parameters assessed, especially regarding the retrolingual region.

Maxillomandibular advancement surgery after long-term use of a mandibular advancement device in a post-adolescent patient with obstructive sleep apnea

Patients with obstructive sleep apnea (OSA) whose phenotype belongs to a craniofacial vulnerability are referred from sleep doctors to orthodontists. In adults, for osseo-pharyngeal reconstruction (OPR) treatment, permanent maxillomandibular advancement (MMA) surgery and use of a temporary mandibular advancement device (MAD) are applied. This case report demonstrates successful treatment of OSA through application of phased MAD and MMA in a 16-year-old male with craniofacial deformity and residual growth potential. This patient showed skeletal and dentoalveolar changes after 7-year MAD use throughout post-adolescence, which affected the design and timing of subsequent MMA surgery, as well as post-surgical orthodontic strategy. This case report suggests that OPR treatment can be useful for treatment of OSA in post-adolescent patients, from an orthodontic point of view, in close collaboration with sleep doctors for interdisciplinary diagnosis and treatment.

Morphological impact on patients of maxillomandibular advancement surgery for the treatment of obstructive sleep apnea-hypopnea syndrome

INTRODUCTION

The aim of this study is to evaluate the experience of patients who have benefited from maxillomandibular advancement surgery for the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS), and also the morphological modifications measured on pre- and postoperative lateral headfilms.

PATIENTS AND METHODS

Twenty-three patients aged 24 to 64 (M=46.8) who had undergone bimaxillary advancement osteotomy for the treatment of OSAHS filled in a questionnaire concerning their overall satisfaction following surgery, the modification of their facial appearance as perceived by themselves and their family and friends, the change in their smile, and the slimmer and more youthful appearance of their face. Measurements of bone and skin points were also performed on lateral cephalograms before and after surgery so as to assess the advancement of the bony bases (maxillary, mandibular and chin advancement) and the impact on soft tissue by analysis of the skin profile.

RESULTS

A total of 91.3% of the patients were satisfied overall following the surgical procedure; 78.3% considered that their faces were improved or unchanged; 39.1% found their faces slimmer and 34.8% thought they looked more youthful. Average maxillary, mandibular and chin advancements with respect to the base of the skull were, respectively, 7.4mm, 11.1mm and 14.1mm. Advancement of the stomion point with respect to the Frankfurt plane was 8.3mm on average, reflecting a significant forward movement of the upper and lower lips.

CONCLUSION

Despite greater maxillary and mandibular advancements than in traditional orthognathic surgery, patients reacted positively to these morphological changes, considering in more than a third of cases that their faces looked slimmer or more youthful. It can thus be concluded that overall satisfaction is high, with a morphological impact that is satisfactory and well-accepted by patients postoperatively.

Effects of maxillomandibular advancement on systemic blood pressure in patients with obstructive sleep apnoea

Obstructive sleep apnoea (OSA) is associated with resistant hypertension. We investigated to what extent maxillomandibular advancement affected a patient's blood pressure postoperatively. We retrospectively analysed consecutive patients who had Bimaxillary advancement for OSA at our hospital following referral from the local sleep clinic. We collected relevant data on clinical characteristics and explored the changes in systolic and diastolic blood pressures, as well as mean arterial pressure (MAP) preoperatively, with those taken 6 months following surgery. We identified 51 patients with a mean (SD) age of 44 (8) years and a mean (SD) body mass index of 29 (3.4). Preoperative and postoperative data on blood pressure were available for analysis in 45. The mean (SD) systolic blood pressure was significantly reduced in our sample following surgery (from 131(12.6) to 127 (12.5)mmHg, p<0.001). The mean (SD) reduction in postoperative MAP values in the overall group, approached statistical significance (recorded MAP 96.6(10) to 93.1(8)mmHg, p=0.06). In a subgroup of 10 patients who had established hypertension the reduction in values postoperatively (mean reduction: systolic blood pressure 6 mmHg, diastolic blood pressure 10 mmHg, mean arterial pressure 9 mmHg) was greater than that observed in the overall group. Our results have shown an improvement in systemic blood pressure after maxillomandibular advancement for OSA, particularly in those with established hypertension. The data suggest that in addition to being a highly effective treatment for OSA, this surgery may more effectively lower systemic blood pressure than other treatment modalities.