Can Patient Selection for MMA Surgery be Improved?

Abstract

Statement of problemMaxillomandibular advancement (MMA) surgery is an effective option for the treatment of obstructive sleep apnea (OSA), but carries the risk of higher morbidity in adults. The aim of this study was to optimize patient selection for MMA surgery by identifying predictors of surgical success. Materials and methodsA retrospective study was approved by the University of Michigan Medical IRB (HUM00188166). Individuals who received maxillomandibular advancement surgery for OSA at Michigan Medicine between 2000 and 2020 were evaluated for inclusion. Inclusion criteria included a diagnosis of OSA and treatment with MMA surgery, an initial AHI of > 15, and age 18 or older. Outcomes included surgical success, defined as a postop AHI < 15 and mean change in AHI from baseline. Methods of data analysisMeans and standard deviations were computed, as well as descriptive statistics. Univariate and multivariate regression analysis were performed. Data were analyzed using SAS v. 8.0. Significance level was set at P < .05. Results and outcome dataIn total,35 patients were included in the study sample. Four subjects were female and the remainder male. Average age was 46.57 years. A regression model demonstrated that preop AHI was predictive of mean AHI change (-.826, P < .0001) but not of surgical success (P = .065). Pre-operative mandibular length was predictive of surgical success (P = .0028). Factors that predicted an AHI change included pre-operative BMI (P = .048) and SpO2 < 88% (P = .0098). ConclusionThe findings suggest that baseline mandibular retrognathia and the central apnea index were predictive of surgical success (AHI < 15). Moreover, pre-operative AHI, BMI, and time spent with an oxygen saturation below 88% were predictive of change in AHI.