Abstract | OBJECTIVE: To report the efficacy of maxillomandibular advancement (MMA) surgery, with a description of several innovations, as a site-specific treatment of obstructive sleep apnea syndrome (OSAS) in selected cases with disproportionate velo-orohypopharyngeal anatomy. DESIGN: Clinical series of 50 consecutive cases. SETTING: Surgery was performed in a hospital operating room, and perioperative management was provided in an intensive care environment. Except for polysomnography (PSG), which was performed and interpreted by independent sleep facilities/physicians, all pre- and postoperative evaluations were accomplished in a solo office private practice setting. PATIENTS: INTERVENTIONS: MMA consisted of a Lefort I osteotomy, bilateral sagittal split ramus osteotomies, and a new modified procedure called an anterior inferior mandibular osteotomy with indirect hyoid suspension. Some patients also received concomitant adjunctive nonpharyngeal procedures. MEASUREMENTS AND RESULTS: Obtained at a mean of 5.2 months postoperatively, revealed significant improvement in all cases. Mean BPs (n = 50) were lowered, subjective symptoms were ameliorated, and mean body mass index (n = 50) was reduced. Cephalometric analysis (n = 50), with several new modifications including standardization for phases of respiration, quantified structural changes in soft-tissue and bony landmarks. Postoperative PSG results (n = 50) showed dramatic improvement over preoperative data (n = 50), with therapeutic values similar to nCPAP (n = 42). Mean values improved from preoperative to postoperative vs nCPAP for apnea index (34.5 to 1.0 vs 2.0, respectively), apnea-hypopnea index (59.2 to 4.7 vs 5.4, respectively), lowest arterial oxyhemoglobin desaturations (72.7% to 88.6% vs 88.6%, respectively), and number of desaturations < 90% (118.8 to 6.6 vs 2.4, respectively). The success rate was 100%. CONCLUSION: MMA is highly successful and safe and may be a definitive primary single-staged surgical treatment of selected OSAS cases with diffusely complex or multiple sites of disproportionate velo-orohypopharyngeal anatomy.
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Authors | J R Prinsell |
Journal | Chest
(Chest)
Vol. 116
Issue 6
Pg. 1519-29
(Dec 1999)
ISSN: 0012-3692 [Print] United States |
PMID | 10593771
(Publication Type: Journal Article)
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Topics |
- Adult
- Aged
- Cephalometry
- Female
- Humans
- Male
- Mandibular Advancement
(instrumentation)
- Middle Aged
- Osteotomy
- Sleep Apnea Syndromes
(complications, surgery)
- Treatment Outcome
- Velopharyngeal Insufficiency
(complications)
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