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.
⁎Research Associate and Resident, Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
†Private Practice, Department of Oral and Maxillofacial Surgery, Isala Clinics, Zwolle, The Netherlands
‡Professor, Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
§Professor and Chairman, Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Address correspondence and reprint requests to Dr Hoekema: Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
This article was written in partial fulfillment of the requirements for a PhD degree. Financial support for this MD-clinical research traineeship was granted by the Netherlands Organisation for Health Research and Development.
ABSTRACT