Maxillomandibular advancement for treatment of obstructive sleep apnea

Abstract

I congratulate AlSaty et al for their article in October 2020 (AlSaty G, Xiang J, Burns M, Eliliwi M, Palomo JM, Martin C, et al. Follow-up observation of patients with obstructive sleep apnea treated by maxillomandibular advancement. Am J Orthod Dentofacial Orthop 2020;158:527-34). The research provides valuable information about the airway changes in patients with obstructive sleep apnea syndrome (OSAS) treated with maxillomandibular advancement (MMA). The authors indicated that the aim of their study was to follow-up airway changes in patients with OSAS treated with MMA procedure with or without genial tubercle advancement. Although the article mentions the cone-beam computed tomography parameters, it does not reflect on the clinical improvement in their sample patients. What was the qualitative outcome of the patient? Because the main purpose of maxillomandibular advancement is to make an improvement in the sleep-disordered breathing and a better quality of life, it is not clear if a follow-up was done on that aspect? In the discussion, the authors wrote, “The MMA procedure has a higher efficacy for lowering the apnea-hypopnea index.”1Varghese R. Adams N.G. Slocumb N.L. Viozzi C.F. Ramar K. Olson E.J. Maxillomandibular advancement in the management of obstructive sleep apnea.Int J Otolaryngol. 2012; 2012: 373025Crossref PubMed Google Scholar However, they did not mention if the apnea-hypopnea index was lowered in their study sample along with the improvement in the airway observed in the cone-beam computed tomography. It would be more meaningful in terms of clinical application if the authors included how the patients improved clinically. In Table IV, we see that the difference in total airway volume and minimal cross-sectional area between T4 (Follow up visit) and T3 (Immediately after MMA procedure) is significant. So, how did it reflect clinically with the patient's condition? Was there any relapse of OSAS or return of symptoms? Follow-up observation of patients with obstructive sleep apnea treated by maxillomandibular advancementAmerican Journal of Orthodontics and Dentofacial OrthopedicsVol. 158Issue 4PreviewThis study aimed to evaluate the follow-up observation of patients with obstructive sleep apnea treated with maxillomandibular advancement (MMA) procedure with or without genial tubercle advancement (GTA). Full-Text PDF Authors' responseAmerican Journal of Orthodontics and Dentofacial OrthopedicsVol. 159Issue 4PreviewWe appreciate the interest and the insightful comments on our article. Full-Text PDF