Maxillomandibular advancement is a successful treatment for obstructive sleep apnoea: a systematic review and meta-analysis.

The primary objective of this review was to establish the effectiveness of maxillomandibular advancement (MMA) as a successful treatment modality in improving airway patency in patients with obstructive sleep apnoea (OSA). A systematic and detailed search was performed using PubMed Central, covering the period January 2000 to December 2015, with well-defined selection criteria. The authors independently conducted the study selection, data extraction, and assessed the risk of bias of the included studies. Twenty studies met the inclusion criteria. The outcome measures studied were the apnoea-hypopnoea index (AHI), respiratory disturbance index (RDI), Epworth Sleepiness Scale (ESS), lowest oxygen saturation (LSAT), and body mass index (BMI). The random-effects model was adopted for meta-analysis as moderate heterogeneity was identified. The analysis revealed significant changes in the outcome measures after the intervention. The results showed that the preoperative severity of OSA based on AHI and RDI significantly influences the outcome of MMA intervention, with a strong positive correlation between the pre MMA AHI values and the percentage change post intervention. The surgical success of MMA in patients with OSA was found to be 100% with respect to AHI and RDI scores. It is concluded that MMA is a successful treatment for OSA.

A comparative assessment of maxillary perfusion between two different Le Fort I osteotomy techniques.

Compromised maxillary perfusion following Le Fort I osteotomy is a potentially serious complication resulting in hard and/or soft tissue loss. The aim of this study was to compare the change in perfusion between two techniques of posterior maxillary disjunction by intraoperative measurement of maxillary gingival blood flow (GBF). Further, we sought to correlate the association of the movement of the maxilla and estimated blood loss as factors. The study population comprised 38 individuals, divided equally into two groups: a pterygoid disjunction group and a third molar socket disjunction group. GBF was measured using Doppler flowmetry. A P-value of <0.05 was considered significant. There was a significant drop in GBF in both groups. However, there was no significant difference between the groups based on magnitude of blood flow drop. Superior repositioning of the osteotomized maxilla caused the greatest drop in GBF, which was statistically significant. There was significantly less blood loss in the pterygoid disjunction group. In conclusion, Le Fort I osteotomy causes a significant decrease in GBF. The technique used for posterior maxillary disjunction does not influence the magnitude of drop in perfusion. There is a significant correlation of other factors such as the effect of superior repositioning of the maxilla and blood loss with the osteotomy techniques.