Maxillomandibular Advancement Surgery for the Treatment of Moderate-Severe Obstructive Sleep Apnea: A Systematic Review

Abstract

StatementThe purpose of this study was to systematically review the literature evaluating the effectiveness of maxillomandibular advancement (MMA) surgery for the treatment of moderate and severe obstructive sleep apnea (OSA).Materials and MethodsA literature search of obstructive sleep apnea from 1970 up to December 2005 identified 16 studies reporting on the use of MMA to treat OSA. Studies were selected based on pre-determined inclusion and exclusion criteria. Studies were excluded if the surgical techniques were not clearly defined, the study had less than 10 cases, duplicate data were reported or included patients less than 18 years old. Included studies had pre and postoperative AHI/RDI along with pre and postoperative polysomnographs.Method of Data AnalysisStudent t-tests were used for statistical analysis. Two groups were established: Group 1 included MMA alone or with adjunctive soft-hard tissue surgery in one surgical procedure and Group 2 included MMA subsequent to failed Phase I (UPPP and/or, genioglossal advancement, and/or, hyoid myotomy) surgery.ResultsSeven studies met our inclusion and exclusion criteria for detailed analysis. MMA was performed on a total of 259 patients. The mean age of the study groups was 44.3±1.43. Eighty-eight percent of the subjects were males. Group 1 had a total of 129 patients and group 2 had a total of 130 patients. The mean preoperative AHI/RDI in Groups 1 and 2 were 56.4±5.95 and 63.7±4.5 respectively. Group 1 and 2 both showed a significant difference between the pre and postoperative AHI/RDI (p<0.001). MMA was successful in achieving a mean postoperative AHI/RDI ≤ 20 in 94% of the patients. There was no significant difference between the success rates of groups 1 and 2.ConclusionMaxillomandibular advancement with adjunctive soft tissue surgery is very effective in treating patients with moderate or severe obstructive sleep apnea. Clinicians should base treatment on the severity of the disease and the anatomic site of airway obstruction. Staging surgical treatment may delay correction of obstructive sleep apnea and consideration should be given to single staged surgical correction in patients with moderate or severe obstructive sleep apnea. StatementThe purpose of this study was to systematically review the literature evaluating the effectiveness of maxillomandibular advancement (MMA) surgery for the treatment of moderate and severe obstructive sleep apnea (OSA). The purpose of this study was to systematically review the literature evaluating the effectiveness of maxillomandibular advancement (MMA) surgery for the treatment of moderate and severe obstructive sleep apnea (OSA). Materials and MethodsA literature search of obstructive sleep apnea from 1970 up to December 2005 identified 16 studies reporting on the use of MMA to treat OSA. Studies were selected based on pre-determined inclusion and exclusion criteria. Studies were excluded if the surgical techniques were not clearly defined, the study had less than 10 cases, duplicate data were reported or included patients less than 18 years old. Included studies had pre and postoperative AHI/RDI along with pre and postoperative polysomnographs. A literature search of obstructive sleep apnea from 1970 up to December 2005 identified 16 studies reporting on the use of MMA to treat OSA. Studies were selected based on pre-determined inclusion and exclusion criteria. Studies were excluded if the surgical techniques were not clearly defined, the study had less than 10 cases, duplicate data were reported or included patients less than 18 years old. Included studies had pre and postoperative AHI/RDI along with pre and postoperative polysomnographs. Method of Data AnalysisStudent t-tests were used for statistical analysis. Two groups were established: Group 1 included MMA alone or with adjunctive soft-hard tissue surgery in one surgical procedure and Group 2 included MMA subsequent to failed Phase I (UPPP and/or, genioglossal advancement, and/or, hyoid myotomy) surgery. Student t-tests were used for statistical analysis. Two groups were established: Group 1 included MMA alone or with adjunctive soft-hard tissue surgery in one surgical procedure and Group 2 included MMA subsequent to failed Phase I (UPPP and/or, genioglossal advancement, and/or, hyoid myotomy) surgery. ResultsSeven studies met our inclusion and exclusion criteria for detailed analysis. MMA was performed on a total of 259 patients. The mean age of the study groups was 44.3±1.43. Eighty-eight percent of the subjects were males. Group 1 had a total of 129 patients and group 2 had a total of 130 patients. The mean preoperative AHI/RDI in Groups 1 and 2 were 56.4±5.95 and 63.7±4.5 respectively. Group 1 and 2 both showed a significant difference between the pre and postoperative AHI/RDI (p<0.001). MMA was successful in achieving a mean postoperative AHI/RDI ≤ 20 in 94% of the patients. There was no significant difference between the success rates of groups 1 and 2. Seven studies met our inclusion and exclusion criteria for detailed analysis. MMA was performed on a total of 259 patients. The mean age of the study groups was 44.3±1.43. Eighty-eight percent of the subjects were males. Group 1 had a total of 129 patients and group 2 had a total of 130 patients. The mean preoperative AHI/RDI in Groups 1 and 2 were 56.4±5.95 and 63.7±4.5 respectively. Group 1 and 2 both showed a significant difference between the pre and postoperative AHI/RDI (p<0.001). MMA was successful in achieving a mean postoperative AHI/RDI ≤ 20 in 94% of the patients. There was no significant difference between the success rates of groups 1 and 2. ConclusionMaxillomandibular advancement with adjunctive soft tissue surgery is very effective in treating patients with moderate or severe obstructive sleep apnea. Clinicians should base treatment on the severity of the disease and the anatomic site of airway obstruction. Staging surgical treatment may delay correction of obstructive sleep apnea and consideration should be given to single staged surgical correction in patients with moderate or severe obstructive sleep apnea. Maxillomandibular advancement with adjunctive soft tissue surgery is very effective in treating patients with moderate or severe obstructive sleep apnea. Clinicians should base treatment on the severity of the disease and the anatomic site of airway obstruction. Staging surgical treatment may delay correction of obstructive sleep apnea and consideration should be given to single staged surgical correction in patients with moderate or severe obstructive sleep apnea.