Maxillomandibular advancement surgery
On March 28, 2023, PhD candidate Ning Zhou from ACTA will defend her thesis entitled ‘Maxillomandibular advancement surgery: New insight into its role in obstructive sleep apnea management’ in Amsterdam. Ning Zhou received a contribution from NVTS for her defense costs. Below is a summary of the thesis.
Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder, which is characterized by repetitive episodes of complete or partial upper airway collapse during sleep. Maxillomandibular advancement (MMA) is a multilevel skeletal surgery in which the maxilla and mandible are advanced by a combination of a Le Fort I osteotomy of the maxilla and a bilateral sagittal split osteotomy of the mandible. MMA has been considered as a highly effective surgical therapy for moderate to severe OSA.
In this thesis, it was found that there was no significant difference in the effects of MMA on respiratory function and facial esthetics between OSA patients with and without maxillomandibular deficiency (i.e., anteroposterior skeletal deficiency). This supports the view that MMA could also be considered as an appropriate treatment for OSA patients without such deficiency.
Additionally, the presence of cardiovascular disease, higher baseline central apnea index, larger superior posterior airway space, and presence of complete anteroposterior epiglottic collapse during drug-induced sleep endoscopy were independently associated with non-response to MMA.
Besides, this thesis compared the clinical efficacy and safety between MMA and other multilevel approaches (multilevel surgery [MLS] and upper airway stimulation [UAS]) for OSA. Compare to MLS, MMA might be a more effective therapy in improving OSA. However, the rates of major and minor complications of MMA were higher than those of MLS. Due to the noticeable differences between MMA cohort and UAS cohort in age and baseline apnea hypopnea index in the literature, a solid conclusion cannot be drawn about the comparison between these two therapies.