Maxillomandibular advancement Surgery in Morbidly Severe Obstructive Sleep Apnea: A 2-year follow-up
Main Article Content
Abstract
Obstructive sleep apnea syndrome is a common disorder characterized by recurrent episodes of upper airway obstruction during sleep. Its prevalence is estimated at 2% to 4% among middle-aged adults (30 to 60 years), while approximately 1% of children are also affected. OSAS is now recognized as an independent risk factor for cardiovascular diseases, highlighting the importance of early diagnosis and appropriate treatment.
Polysomnography remains the gold standard for diagnosing obstructive sleep apnea syndrome. Therapeutically, nasal continuous positive airway pressure is considered the first-line treatment for both snoring and obstructive sleep apnea. Oral appliances may be used in mild to moderate cases. However, in severe forms of the condition, especially when associated with craniofacial abnormalities, maxillomandibular advancement is often the only effective option capable of providing long-term improvement.
This case report presents the management of a 27-year-old male patient with obstructive sleep apnea syndrome, associated with a significant mandibular retrognathia. The treatment plan involved maxillomandibular advancement, with the objective of increasing the oropharyngeal airway volume. The surgical outcome was favorable, offering a definitive resolution of the patient’s obstructive sleep apnea syndrome.
Article Details
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
2. Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002.
3. Peppard PE, Young T, Barnet JH, et al. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177:1006.
4. Boyaci H, Gacar K, Baris SA, et al. Positive airway pressure device compliance of the patients with obstructive sleep apnea syndrome. Adv Clin Exp Med. 2013;22:809.
5. Hsieh YJ, Liao YF. Effects of maxillomandibular advancement on the upper airway and surrounding structures in patients with obstructive sleep apnoea: a systematic review. Br J Oral Maxillofac Surg. 2013;51:834.
6. Vezina J, Blumen M, Buchet I, et al. Sleep-disordered breathing: choosing the right cephalometric analysis. J Oral Maxillofac Surg. 2012;70:1442.
7. Li KK. Surgical management of obstructive sleep apnea. Clin Chest Med. 2003;24(2):365-370.
8. Gokce SM, Gorgulu S, Gokce HS, Bengi AO, Karacayli U, Ors F. Evaluation of pharyngeal airway space changes after bimaxillary orthognathic surgery with a 3-dimensional simulation and modeling program. Am J Orthod Dentofacial Orthop. 2014;146(4):477-492.
9. Okesenberg A, Arons E, Nasser K, et al. Severe obstructive sleep apnea: sleepy versus nonsleepy patients. Laryngoscope. 2010;120:643.
10. Goodday RH, Bourque SE, Edwards PB. Objective and subjective outcomes following maxillomandibular advancement surgery for treatment of patients with extremely severe obstructive sleep apnea (AHI >100). J Oral Maxillofac Surg. 2015 Jul 20.
11. Doff MHJ, Jansma J, Schepers RH, Hoekema A. Maxillomandibular advancement surgery as alternative to continuous positive airway pressure in morbidly severe obstructive sleep apnea: a case report. Cranio. 2013.
12. Butterfield KJ, Marks PLG, McLean L, Newton J. Linear and volumetric airway changes after maxillomandibular advancement for obstructive sleep apnea. J Oral Maxillofac Surg. 2015;73:1133-1142.
13. Holty JE, Guilleminault C. Maxillomandibular advancement for the treatment of obstructive sleep apnea: a systematic review and meta-analysis. Sleep Med Rev. 2010;14(5):287-297.
14. Boyd SB, Walters AS, Song Y, Wang L. Comparative effectiveness of maxillomandibular advancement and uvulopalatopharyngoplasty for the treatment of moderate to severe obstructive sleep apnea. J Oral Maxillofac Surg. 2013.
15. De Souza Carvalho AC, Magro Filho O, Garcia IR Jr, et al. Cephalometric and three-dimensional assessment of superior posterior airway space after maxillomandibular advancement. Int J Oral Maxillofac Surg. 2012;41:1102
16. Boyd SB, Walters AS, Song Y, Wang L. Comparative effectiveness of maxillomandibular advancement and uvulopalatopharyngoplasty for the treatment of moderate to severe obstructive sleep apnea. Oral Maxillofac Surg. 2012 Dec.
17. Goodday RH, Bourque S. Subjective outcomes of maxillomandibular advancement surgery for treatment of obstructive sleep apnea syndrome. J Oral Maxillofac Surg. 2012;70:417.
18. Boyd SB, Walters AS, Waite P, Harding SM, Song Y. Long-term effectiveness and safety of maxillomandibular advancement for treatment of obstructive sleep apnea. J Clin Sleep Med. 2015 Jul.
19. John CR, Gandhi S, Sakharia AR, James TT. Maxillomandibular advancement is a successful treatment for obstructive sleep apnoea: a systematic review and meta-analysis. Int J Oral Maxillofac Surg. 2018.
20. Cillo JE Jr, Dattilo DJ. Maxillomandibular advancement for obstructive sleep apnea produces long-term horizontal advancement of the maxilla and mandible. J Oral Maxillofac Surg. 2019.
21. Lye KW, Waite PD, Meara D, Wang D. Quality of life evaluation of maxillomandibular advancement surgery for treatment of obstructive sleep apnea. J Oral Maxillofac Surg. 2008 May.
22. Friedman M, Wilson M. Re-redefining success in airway surgery for obstructive sleep apnea [comment]. Sleep. 2009;32(1):17.
http://orcid.org/0000-0002-2954-5237