Oral appliances and maxillomandibular advancement surgery: an alternative treatment protocol for the obstructive sleep apnea-hypopnea syndrome.

Abstract

PURPOSE:

The present study comprises a retrospective evaluation of the potential application of mandibular repositioning appliance (MRA) therapy preceding maxillomandibular advancement (MMA) surgery in the treatment of the Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS). Our initial experiences with a new surgical protocol, in which MRA therapy serves as a predictor for success of MMA surgery, are reported.

PATIENTS AND METHODS:

Forty-three consecutive patients with OSAHS treated with MRA therapy were considered for inclusion (mean+/-SD; Apnea-Hypopnea Index [AHI]=27+/-20; age=53+/-9 years). All patients displaying a substantial improvement in their AHI with MRA therapy (ie,>50% reduction) who preferred surgical rather than "prosthetic" advancement of the mandible were offered MMA surgery. Accordingly, 4 out of 43 patients were treated with MMA surgery. The AHI was used as the primary outcome measure, with MMA surgery being considered successful in case of a postoperative AHI <5.

RESULTS:

All 4 patients included displayed substantial improvement in their AHI following MRA therapy. Moreover, in 3 patients MRA therapy resulted in a post-treatment AHI <or=5. With respect to the primary outcome measure, successful OSAHS management was attained in all 4 patients following MMA surgery.

CONCLUSION:

Results from the 4 patients included in the present study suggest that MRA therapy might be a good predictor for the success of MMA surgery in OSAHS management. Although confirmation in a larger study sample is indicated, we conclude that patients with a substantial reduction in baseline AHI with MRA therapy appear to be candidates for MMA surgery.

• Authors: Aarnoud Hoekema, Jan de Lange, Boudewijn Stegenga, Lambert G M de Bont
• Journal: Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons (J Oral Maxillofac Surg) Vol. 64 Issue 6 Pg. 886-91 (Jun 2006) ISSN: 0278-2391 [Print] United States
• PMID: 16713801 (Publication Type: Evaluation Study, Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Clinical Protocols
• Humans
• Jaw Fixation Techniques (instrumentation)
• Mandibular Advancement (instrumentation, methods)
• Maxilla (surgery)
• Middle Aged
• Orthodontic Appliances
• Preoperative Care
• Prognosis
• Retrospective Studies
• Sleep Apnea, Obstructive (surgery, therapy)
• Treatment Outcome