Maxillomandibular Advancement (MMA) in a Site-Specific Treatment Approach for Obstructive Sleep Apnea: A Surgical Algorithm

ABSTRACT

Maxillomandibular advancement (MMA) is the most successful acceptable surgical treatment, excluding tracheostomy, for obstructive sleep apnea syndrome (OSAS). Nevertheless, the indications for and staging of MMA, with respect to the many procedures available, are unsettled and often limited to severe OSAS, dentocraniofacial deformities, and when other surgeries have failed. An algorithm is presented that defines the indications for MMA in an expanded role, based on a site-specific approach, according to proposed principles that include general goals and guidelines for governing the surgical treatment of OSAS.

KEYWORD

maxillomandibular advancement - sleep apnea - surgery

REFERENCES

• 1 Hochban W, Bradendurg U, Peter J H. Surgical treatment of obstructive sleep apnea by maxillomandibular advancement.  Sleep . 1994;  17 624-629
• 2 Prinsell J. Maxillomandibular advancement surgery in a site-specific treatment approach for obstructive sleep apnea in 50 consecutive patients.  Chest . 1999;  116 1519-1529
• 3 Waite P D, Wooten V, Lachner J. Maxillomandibular advancement surgery in 23 patients with obstructive sleep apnea syndrome.  J Oral Maxillofac Surg . 1989;  47 1256-1261
• 4 Hochban W, Conradt R, Brandenburg U. Surgical maxillofacial treatment of obstructive sleep apnea.  Plast Reconstr Surg . 1997;  99 619-626
• 5 Riley R W, Powell N B, Guilleminalt C. Obstructive sleep apnea syndrome: a review of 306 consecutively treated surgical patients.  Otolaryngol Head Neck Surg . 1993;  108 117-125
• 6 American Sleep Disorders Association. Practice parameters for the treatment of obstructive sleep apnea in adults: the efficacy of surgical modifications of the upper airway.  Sleep . 1996;  19 152-155
• 7 Fairbanks D NF. Uvulopalatopharyngoplasty complications and avoidance strategies.  Otolaryngol Head Neck Surg . 1990;  102 239-245
• 8 Haavisto L, Suonpaa J. Comlications of uvulopalatopharyngoplasty.  Clin Otolaryngol . 1994;  19 243-247
• 9 Zohar Y, Findelstein Y, Talmi Y P. Perioperative complications and risk factors in the surgical treatment of obstructive sleep apnea syndrome.  Laryngoscope . 1989;  1125-1129
• 10 American Sleep Disorders Association. Practice parameters for use of laser-assisted uvulopalatoplasty.  Sleep . 1994;  8 744-748
• 11 Esclamado R M, Glenn M G, McCulloch T M, Cummings C W. Perioperative complications and risk factors in the surgical treatment of obstructive sleep apnea syndrome.  Laryngoscope . 1989;  99 1125-1129
• 12 Riley R W, Powell N B, Guilleminault C. Obstructive sleep apnea syndrome: a surgical protocol for dynamic upper airway reconstruction.  J Oral Maxillofac Surg . 1993;  51 742-747
• 13 Fujita S, Conway W, Zorick F. Surgical correction of anatomic abnormalities in obstructive sleep apnea syndrome: uvulopalatopharyngoplasty.  Otolaryngol Head Neck Surg . 1981;  89 923-934
• 14 Sher A E, Schechtman K B, Piccirillo J F. The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome.  Sleep . 1996;  19 156-177
• 15 Djupesland G, Schrader H, Lyberg T. Palatopharyngoglossoplasty in the treatment of patients with obstructive sleep apnea syndrome.  Acta Orolaryngol (Stockh) . 1992;  492(Suppl 0) 504
• 16 Miljeteig H, Tvinnereim M. Uvulopalatopharygoglossoplasty (UPPGP): in the treatment of the obstructive sleep apnea syndrome.  Acta Orolaryngol (Stockh) . 1992;  492(Suppl 0) 86-89
• 17 Powell N B, Riley R W, Troell R J. Radiofrequency volumetric reduction of the tongue: a porcine pilot study for the treatment of obstructive sleep apnea sydrome.  Chest . 1997;  111 1348-1355
• 18 Powell N B, Riley R W, Troell R J. Radiofrequency volumetric tissue reduction of the palate in subjects with sleep-disordered breathing.  Chest . 1998;  113 1163-1174
• 19 Wassmuth Z, Leonard D, Mair E. Cautery-assisted palatal stiffening operation for the treatment of obstructive sleep apnea (abstract).  Otolaryngol Head Neck Surg . 1998;  119 144-145
• 20 Powell N, Riley R, Guilleminault C. A reversible uvulopalatal flap for snoring and sleep apnea syndrome.  Sleep . 1996;  19 593-599
• 21 Fujita S, Woodson B T, Clark J L. Laser midline glossectomy as a treatment for obstructive sleep apnea.  Laryngoscope . 1991;  101 805-809
• 22 Mickelson S, Rosenthal L. Midline glossectomy and epiglottidectomy for obstructive sleep apnea syndrome.  Laryngoscope . 1997;  107 614-619
• 23 Woodson B T, Fujita S. Clinical experience with lingualplasty as part of the treatment of severe obstructive sleep apnea.  Otolaryngol Head Neck Surg . 1992;  107 40-48
• 24 Ronald J, Delaive K, Roos L. Healthcare utilization in the 10 years prior to diagnosis in obstructive sleep apnea syndrome patients.  Sleep . 1999;  22 225-229
• 25 Bahammam A, Dlaive K, Ronald J. Healthcare utilization in males with obstructive sleep apnea syndrome two years after diagnosis and treatment.  Sleep . 1999;  22 740-747
• 26 Kapur V, Blough D, Sandblom R. The medical cost of undiagnosed sleep apnea.  Sleep . 1999;  22 749-755
• 27 Riley R W, Powell N B, Li K K. Surgery and obstructive sleep apnea: long-term clinical outcomes.  Otolaryngol Head Neck Surg . 2000;  122 415-421