Maxillomandibular advancement effectively treats obstructive sleep apnea.

Zaghi S, et al. JAMA Otolaryngol Head Neck Surg. 2015;doi:10.1001/jamaoto.2015.2678.

December 14, 2015

Maxillomandibular advancement was effective in treating patients with obstructive sleep apnea, according to recent data from a retrospective review.

“Maxillomandibular advancement is a highly effective treatment for [obstructive sleep apnea (OSA)]. Preoperative severity of OSA is the most reliable predictor of outcome effect size and the likelihood of surgical success and cure,” Soroush Zaghi, MD, from the David Geffen School of Medicine at the University of California, Los Angeles, and colleagues wrote. “Those patients with the most severe measures of OSA tend to benefit to the greatest degree. Patients with less severe measures of OSA experience a smaller magnitude of change in [apnea-hypopnea index (AHI)] or [respiratory disturbance index (RDI)] postoperatively, but they have the highest chance of achieving surgical success and cure. Patients with high residual RDI and AHI scores (despite prior treatments by means of uvulopalatopharyngoplasty, partial glossectomy, and/or nasal surgery) are highly likely to benefit from management of OSA by means of [maxillomandibular advancement (MMA)].”

Zaghi and colleagues reviewed the MEDLINE, Cochrane Library, Scopus and Web of Science databases using keywords related to orthognathic surgery, MMA and OSA between June 2014 and March 2015 to identify 45 studies that met inclusion criteria. Studies were included if patients underwent MMA and if there were preoperative and postoperative data for AHI and RDI scores as well as individual patient data, according to the abstract.

Overall, 98% of patients showed improvement after surgery. Of the 518 patients in the 45 studies identified, 268 patients had data available and 197 patients (73.5%) had undergone previous surgery to treat OSA. The mean postoperative changes after MMA surgery for AHI were –47.8 (SD = 25.0) and –44.4 (SD = 33.0) for RDI, while mean reductions for AHI were 80.1% and 64.6% for RDI, according to the abstract.

The researchers reported significant improvements in mean postoperative oxygen saturation nadir (70.1%-87.0%; SD = 15.6%-5.2%) as well as Epworth Sleepiness Scale scores (13.5-3.2; SD = 5.2-3.2). They noted that, among patients with AHI data, the surgical procedure was successful in 85.5% of patients (n = 389) and cured in 38.5% (n = 175, whereas 64.7% (n = 44) were successful and 19.1% (n = 13) cured among those with RDI data, according to the abstract.

“Preoperative AHI of fewer than 60 events/h was the factor most strongly associated with the highest incidence of surgical cure,” Zaghi and colleagues wrote. “Nevertheless, patients with a preoperative AHI of more than 60 events/h experienced large and substantial net improvements despite modest surgical cure rates.” – by Jeff Craven

Disclosure: The researchers report no relevant financial disclosures.