Subject(s)
Catheterization , Epistaxis , Humans , Airway Management , Catheters , Epistaxis/therapy , Intubation, Intratracheal , SuctionABSTRACT
PURPOSE: Although maxillomandibular advancement (MMA) surgery is highly efficacious for the management of obstructive sleep apnea (OSA), little information exists regarding the subjective effect of this treatment modality. The present study was undertaken to investigate the effect of MMA on patient-perceived quality of life (QOL) in OSA. PATIENTS AND METHODS: A retrospective cohort study of patients treated with MMA for OSA from May 2010 to April 2015 was performed. The primary outcome measure was a change in the QOL detected using the Ottawa Sleep Apnea Questionnaire (OSA-Q), which assesses the MMA-related changes in QOL with a 5-point Likert scale. The secondary outcome measure was a change in the apnea hypopnea index (AHI). RESULTS: Twenty-two patients participated in the present study. The mean maxillary and mandibular advancement were 8.36 and 11.08 mm, respectively. The AHI decreased from 42.4 to 6.9 events per hour postoperatively (P < .001). The QOL improved significantly after MMA (OSA-Q score 3.98 ± 0.35; P < 001). The sleep quality (4.35 ± 0.63), daytime function (4.13 ± 0.46), physical health (4.19 ± 0.45), mental and emotional health (4.02 ± 0.55), and sexual health (3.78 ± 0.62) categories all improved postoperatively (P < .001). The MMA-related side effects did not adversely affect the QOL. CONCLUSIONS: MMA for OSA significantly improves patient's subjective overall QOL, with few MMA-related side effects.
Subject(s)
Mandibular Advancement , Quality of Life , Sleep Apnea, Obstructive/surgery , Female , Humans , Male , Middle Aged , Osteotomy, Le Fort , Osteotomy, Sagittal Split Ramus , Surveys and Questionnaires , Treatment OutcomeABSTRACT
PURPOSE: Maxillomandibular advancement (MMA) surgery is a well-established treatment of obstructive sleep apnea (OSA). Although many studies have assessed the efficacy of MMA in treating OSA, very few studies have quantified the magnitude of its changes to airway morphology. Therefore, the present study investigated the linear and volumetric morphologic changes that occur in the pharyngeal airway after treatment of OSA using MMA. MATERIALS AND METHODS: A retrospective cohort study of patients with OSA treated from May 2010 to February 2014 was performed. Each patient underwent preoperative clinical and fiberoptic nasopharyngoscopic examinations. Pre- and postoperative polysomnograms, lateral cephalograms, and cone-beam computed tomography scans were acquired. The radiographic images were used to determine the linear and volumetric airway measurements. The time and magnitude of skeletal movement were used as the independent variables. The dependent variables included assessment of success or cure, apnea hypopnea index (AHI), cephalometric changes, Epworth score, rapid eye movement sleep, body mass index, and various airway morphologic parameters. RESULTS: A total of 15 patients (13 men and 2 women) participated in the present study. The surgical success and cure rate was 73.33% and 40.00%, respectively. Statistically significant improvements were found in the airway total volume, minimal cross-sectional area, anteroposterior and lateral dimensions, airway index, airway length, posterior airway space morphology, AHI, and Epworth sleepiness score. CONCLUSIONS: MMA is a highly successful surgical treatment of OSA that improves airway morphology and sleep quality. MMA results in a shorter and broader airway and associated improvements in the AHI.
Subject(s)
Mandibular Advancement/methods , Osteotomy, Le Fort/methods , Osteotomy, Sagittal Split Ramus/methods , Pharynx/anatomy & histology , Sleep Apnea, Obstructive/surgery , Adult , Anatomy, Cross-Sectional/methods , Body Mass Index , Cephalometry/methods , Cohort Studies , Cone-Beam Computed Tomography/methods , Endoscopy/methods , Female , Follow-Up Studies , Humans , Imaging, Three-Dimensional/methods , Male , Middle Aged , Nasopharynx/anatomy & histology , Organ Size , Oropharynx/anatomy & histology , Polysomnography/methods , Retrospective Studies , Sleep Stages/physiology , Sleep, REM/physiology , Treatment Outcome , Young AdultABSTRACT
OBJECTIVE: This study investigated the differences in airway morphology between control patients and those with obstructive sleep apnea (OSA) treated with maxillomandibular advancement (MMA) to gain better insight into the beneficial effects of MMA on airway morphology and OSA severity. STUDY DESIGN: This retrospective case-control study included preoperative radiographic data gathered for all patients; postoperative radiographic data were gathered for the OSA group. Statistical analysis, including the Student t test, and simple linear regression was performed to identify differences in cephalometric and airway variables among the three groups and to associate airway morphology to disease severity. RESULTS: Twenty-four patients (12 with OSA; 12 controls) treated at the same clinic were included in this study. Statistically significant differences versus control values were found for preoperative total airway volume, postoperative airway length, and both pre- and postoperative airway minimum cross-sectional areas. In general, the untreated OSA airway was anatomically compromised in comparison with controls, whereas the treated airway showed significant morphologic improvements, comparable with the control group values. CONCLUSIONS: MMA produces statistically significant airway improvements for OSA patients, producing airway morphology comparable with that of the controls. However, some degree of residual OSA may still exist. Therefore, factors other than static airway morphology contribute to OSA pathogenesis.
