Sitawan Navasumrit1, Ying-An Chen2,3,4, Yuh-Jia Hsieh3,4,5, Chuan-Fong Yao2,3,4, Chun-Shin Chang2,3,4, Ning-Hung Chen1,6, Yu-Fang Liao7,8,9,10, Yu-Ray Chen1,2,3,4. 1. College of Medicine, Chang Gung University, Taoyuan, Taiwan. 2. Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan. 3. Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan. 4. Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan. 5. Department of Craniofacial Orthodontics, Guishan District, Chang Gung Memorial Hospital, No. 123, Dinghu Road, Taoyuan City 333, Taiwan. 6. Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan. 7. College of Medicine, Chang Gung University, Taoyuan, Taiwan. yufang@cgmh.org.tw. 8. Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan. yufang@cgmh.org.tw. 9. Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan. yufang@cgmh.org.tw. 10. Department of Craniofacial Orthodontics, Guishan District, Chang Gung Memorial Hospital, No. 123, Dinghu Road, Taoyuan City 333, Taiwan. yufang@cgmh.org.tw.
Abstract
OBJECTIVES: Maxillomandibular advancement (MMA) is an effective short-term treatment for obstructive sleep apnea (OSA). This study aimed to evaluate the long-term stability of the facial skeleton, upper airway, and its surrounding structures, as well as improvement in OSA following MMA. MATERIALS AND METHODS: Thirty-one adults with moderate-to-severe OSA underwent surgery-first modified MMA as primary surgery. Polysomnography and cone-beam computed tomography were obtained pre-surgery, early post-surgery, and at follow-up (i.e., ≥ 2 years post-surgery). Image analysis software assessed the facial skeleton, upper airway, and its surrounding structures. RESULTS: Early post-surgery, apnea-hypopnea index (AHI) had decreased significantly (p < 0.001) and the minimum oxygen saturation (MSAT) increased (p = 0.001), indicating significant improvement in OSA. At follow-up, the AHI and MSAT remained stable. However, the anterior maxilla, soft palate, and tongue moved backward while the hyoid moved downward. There was also a significant decrease in the minimal cross-sectional area of the oropharynx. The reduction in AHI was significantly related to the anterior movement of the anterior maxilla and tongue, inferior movement of the posterior maxilla, and superior movement of the soft palate tip. CONCLUSIONS: The improvement of OSA after modified MMA remained stable for at least 2 years following treatment, despite the relapse of the facial skeleton, upper airway, and its surrounding structures. The reduction of AHI was not related to changes in the caliber of the upper airway but to the movement of the maxilla, soft palate, and tongue. Clinical relevance Modified MMA is clinically effective for long-term treatment of patients with moderate-to-severe OSA.
OBJECTIVES: Maxillomandibular advancement (MMA) is an effective short-term treatment for obstructive sleep apnea (OSA). This study aimed to evaluate the long-term stability of the facial skeleton, upper airway, and its surrounding structures, as well as improvement in OSA following MMA. MATERIALS AND METHODS: Thirty-one adults with moderate-to-severe OSA underwent surgery-first modified MMA as primary surgery. Polysomnography and cone-beam computed tomography were obtained pre-surgery, early post-surgery, and at follow-up (i.e., ≥ 2 years post-surgery). Image analysis software assessed the facial skeleton, upper airway, and its surrounding structures. RESULTS: Early post-surgery, apnea-hypopnea index (AHI) had decreased significantly (p < 0.001) and the minimum oxygen saturation (MSAT) increased (p = 0.001), indicating significant improvement in OSA. At follow-up, the AHI and MSAT remained stable. However, the anterior maxilla, soft palate, and tongue moved backward while the hyoid moved downward. There was also a significant decrease in the minimal cross-sectional area of the oropharynx. The reduction in AHI was significantly related to the anterior movement of the anterior maxilla and tongue, inferior movement of the posterior maxilla, and superior movement of the soft palate tip. CONCLUSIONS: The improvement of OSA after modified MMA remained stable for at least 2 years following treatment, despite the relapse of the facial skeleton, upper airway, and its surrounding structures. The reduction of AHI was not related to changes in the caliber of the upper airway but to the movement of the maxilla, soft palate, and tongue. Clinical relevance Modified MMA is clinically effective for long-term treatment of patients with moderate-to-severe OSA.