Oral Appliances and Maxillomandibular Advancement Surgery: An Alternative Treatment Protocol for the Obstructive Sleep Apnea-Hypopnea Syndrome

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 ≤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.