Why most patients do not exhibit obstructive sleep apnea after mandibular setback surgery?

Jin-Wook Kim,Tae-Geon Kwon

doi:10.1186/s40902-020-00250-x

Jin-Wook Kim, Tae-Geon Kwon

Open Access

https://doi.org/10.1186/s40902-020-00250-x

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Abstract

Maxillomandibular advancement (MMA) is effective for the treatment of obstructive sleep apnea (OSA). In previous studies, the airway was increased in the anteroposterior and transverse dimensions after MMA. However, the effect of the opposite of mandibular movement (mandibular setback) on the airway is still controversial. Mandibular setback surgery has been suggested to be one of the risk factors in the development of sleep apnea. Previous studies have found that mandibular setback surgery could reduce the total airway volume and posterior airway space significantly in both the one-jaw and two-jaw surgery groups. However, a direct cause-and-effect relationship between the mandibular setback and development of sleep apnea has not been clearly established. Moreover, there are only a few reported cases of postoperative OSA development after mandibular setback surgery.These findings may be attributed to a fundamental difference in demographic variables such as age, sex, and body mass index (BMI) between patients with mandibular prognathism and patients with OSA. Another possibility is that the site of obstruction or pattern of obstruction may be different between the awake and sleep status in patients with OSA and mandibular prognathism. In a case-controlled study, information including the BMI and other presurgical conditions potentially related to OSA should be considered when evaluating the airway. In conclusion, the preoperative evaluation and management of co-morbid conditions would be essential for the prevention of OSA after mandibular setback surgery despite its low incidence.

Highlights

For patients with prognathism or skeletal class III malocclusion, mandibular setback surgery is frequently performed to improve esthetic and functional problems
The purpose of this review is to investigate various factors related to postoperative airway changes after mandibular setback surgery and answer the key question: why most patients do not exhibit obstructive sleep apnea (OSA) after a significant amount of mandibular setback?
Mandibular setback surgery may be a risk factor for sleep-disordered breathing considering the evidence of decreased pharyngeal airway volume after surgery

Summary

Introduction

For patients with prognathism or skeletal class III malocclusion, mandibular setback surgery is frequently performed to improve esthetic and functional problems. Two systematic reviews indicated that there was no clear evidence to confirm whether two-jaw surgery or isolated mandibular surgery may be a causative factor of OSA development [1, 7]. A direct cause-and-effect relationship between the mandibular setback and development of sleep apnea has not been clearly established. Positive airway pressure therapy is primarily recommended for patients with severe OSA. When patients with severe OSA cannot tolerate the therapy, maxillomandibular advancement (MMA) is recommended as a surgical option to increase the airway space [8]. A meta-analysis of the efficacy of MMA for treating OSA has been conducted using the results from 45 studies involving 455 patients [9] and clearly showed MMA can improve airway patency. The increase in the transverse airway was even greater than that in the anteroposterior airway [13]

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