Long-Term Results of Maxillomandibular Advancement Surgery

ABSTRACT

Surgery is a major modality in the treatment of obstructive sleep apnea syndrome (OSAS), and maxillomandibular advancement (MMA) has been shown to be the most effective surgical option. However, despite the successful short-term (6-9 months) results reported by various investigators, little is known of the long-term clinical outcomes. A review of our long-term clinical results demonstrated that MMA achieves long-term cure in most patients. Aging and minor weight gain did not appear to have a significant adverse effect on the long-term results; however, major weight gain did seem to have a significant negative impact on the long-term outcomes. Therefore, long-term follow-up with proper counseling on weight maintenance or reduction is essential in improving long-term results.

KEYWORD

obstructive sleep apnea syndrome - sleep apnea surgery - sleep-disordered breathing - maxillomandibular advancement

REFERENCES

• 1 Indications and standards for use of nasal continuous positive airway pressure (CPAP) in sleep apnea syndromes.  Am J Respir Crit Care Med. 1994;  150 1738-1745
• 2 Young T, Palta M, Dempsey J. The occurrence of sleep-disordered breathing among middle-aged adults.  N Engl J Med . 1993;  328 1230-1235
• 3 Kripke D F, Ancoli-Israel S, Klauber M R. Prevalence of sleep-disordered breathing in ages 40-64 years: A population-based survey.  Sleep . 1997;  20 65-76
• 4 Ancoli-Israel S, Klauber M R, Stepnowsky C. Sleep-disordered breathing in African-American elderly.  Am J Respir Crit Care Med . 1995;  152 1946-1949
• 5 Riley R, Guilleminault C, Powell N. Palatopharyngoplasty failure, cephalometric roentgenograms, and obstructive sleep apnea.  Otolaryngol Head Neck Surg . 1985;  93 240-243
• 6 Jamieson A, Guilleminault C, Partinen M, Quera-Salva M A. Obstructive sleep apneic patients have craniomandibular abnormalities.  Sleep . 1986;  9 469-477
• 7 DeBerry-Borowiecki B, Kukwa A, Blanks R. Cephalometric analysis for diagnosis and treatment of obstructive sleep apnea.  Laryngoscope . 1988;  98 226-234
• 8 Powell N B, Guilleminault C, Riley R W. Mandibular advancement and obstructive sleep apnea syndrome.  Bull Eur Physiopathol Respir . 1983;  19 607-610
• 9 Riley R W, Powell N B, Guilleminault C. Obstructive sleep apnea syndrome following surgery for mandibular prognathism.  J Oral Maxillofac Surg . 1987;  45 450-452
• 10 Riley R W, Powell N B. Maxillofacial surgery and obstructive sleep apnea syndrome.  Otolaryngol Clin North Am . 1990;  23 809-826
• 11 Metes A, Hoffstein V, Direnfeld V, Chapnik J S, Zamel N. Three-dimensional CT reconstruction and volume measurements of the pharyngeal airway before and after maxillofacial surgery in obstructive sleep apnea.  J Otolaryngol . 1993;  22 261-264
• 12 Riley R W, Powell N B, Guilleminault C. Obstructive sleep apnea syndrome: A review of 306 consecutively treated surgical patients.  Otolaryngol Head Neck Surg . 1993;  108 117-125
• 13 Riley R W, Powell N B, Guilleminault C. Maxillofacial surgery and obstructive sleep apnea: A review of 80 patients.  Otolaryngol Head Neck Surg . 1989;  101 353-361
• 14 Waite P D, Wooten V, Lachner J, Guyette R F. Maxillomandibular advancement surgery in 23 patients with obstructive sleep apnea syndrome.  J Oral Maxillofac Surg . 1989;  47 1256-1261
• 15 Hochban W, Conradt R, Brandenburg U, Heitmann J, Hermann J. Surgical maxillofacial treatment of obstructive sleep apnea.  Plast Reconstr Surg . 1997;  99 619-626
• 16 Li K K, Riley R W, Powell N B, Troell R J, Guilleminault C. Overview of Phase II Surgery for Obstructive Sleep Apnea Syndrome.  Ear Nose Throat J . 1999;  78 851-857
• 17 Riley R W, Powell N B, Li K K, Troell R J, Guilleminault C. Surgery and obstructive sleep apnea: Long-term clinical outcomes.  Otolaryngol Head Neck Surg . 2000;  122 415-421
• 18 Larsson H, Carlsson-Nordlander B, Svanborg E. Long-time follow-up after UPPP for obstructive sleep apnea syndrome.  Acta Otolaryngol . 1991;  111 582-590
• 19 Larsson L H, Carlsson-Nordlander B G, Svanborg E. Four-year follow-up after uvulopalatopharyngoplasty in 50 unselected patients with obstructive sleep apnea syndrome.  Laryngoscope . 1994;  104 1362-1368
• 20 Browman C P, Sampson M G, Yolles S F. Obstructive sleep apnea and body weight.  Chest . 1984;  85 435-438
• 21 Conradt R, Hochban W, Brandenburg U, Heitmann J, Peter J H. Long-term follow-up after surgical treatment of obstructive sleep apnea by maxillomandibular advancement.  Eur Respir J . 1997;  10 123-128