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Optimizing mandibular sagittal split of large maxillomandibular advancements for obstructive sleep apnea: patient and surgical factors

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Abstract

Objectives

Maxillomandibular advancement (MMA) confers consistent and high rates of surgical success for obstructive sleep apnea (OSA). In the era of value-based medicine, identifying factors that affect the stability of rigid fixation and allow rapid return to function are important targets for improvement. The aim of this study was to identify patient and surgical factors associated with mandibular sagittal split outcomes associated with optimal postoperatively skeletal stability.

Study design

Retrospective cohort study.

Materials and methods

Forty-six subjects (43 males and 3 females) with postoperative CT scans including three-dimensional reconstruction from which mandibular split patterns could be analyzed were enrolled. Patient factors (age and polysomnographic measures) and surgical factors (extent of osteotomy prior to controlled fracture) were assessed. Outcome measures include (1) bone thickness for rigid fixation and (2) area of passive bony overlap after advancement.

Results

Age and severity of disease did not contribute significantly to optimal mandibular split patterns. For optimal area for passive bony overlap and thickness of buccal and lingual plates for rigid fixation, the most important factors are related to surgical technique.

Conclusions

Anterior osteotomy just to the midline of inferior border and horizontal osteotomy to the mandibular foramen are associated with split patterns that result in optimal rigid fixation and passive bony overlap for OSA patients undergoing MMA.

Clinical relevance

Optimal surgical technique has the most significant influence in allowing rapid return to function after MMA in patients with OSA.

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Acknowledgments

The authors would like to thank Dr. Pin-Yuan Chen of Peace Dental Clinic of Kaohsiung, Taiwan, who created the artwork in Figs. 1 and 2.

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Authors and Affiliations

  1. Division of Sleep Surgery, Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, 801 Welch Road, Standford, CA, 94305, USA

    Yu Feng Chen, Soroush Zaghi, Audrey Yoon, Ryan Williams, Robert Riley & Stanley Yung-Chuan Liu

  2. Division of Oral and Maxillofacial Surgery, Kaohsiung Medical University Hospital, No. 100 Tzyou 1st Road, Kaohsiung, 80708, Taiwan

    Yu Feng Chen & Edward Chengchun Ko

  3. School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, No. 100 ShihChuan 1st Road, Kaohsiung, 80708, Taiwan

    Yu Feng Chen & Edward Chengchun Ko

  4. UCLA Santa Monica medical Center, 1250 16th St, Santa Monica, CA, 90404, USA

    Soroush Zaghi

  5. Department of Pediatric Dentistry, UCLA School of Dentistry, 10833 Le Conte Ave, CHS 20-137, Los Angeles, CA, 90095, USA

    Audrey Yoon

Authors
  1. Yu Feng Chen
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  2. Edward Chengchun Ko
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  4. Audrey Yoon
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  7. Stanley Yung-Chuan Liu
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Corresponding author

Correspondence to Stanley Yung-Chuan Liu.

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Chen, Y.F., Ko, E.C., Zaghi, S. et al. Optimizing mandibular sagittal split of large maxillomandibular advancements for obstructive sleep apnea: patient and surgical factors. Clin Oral Invest 24, 1359–1367 (2020). https://doi.org/10.1007/s00784-019-03017-5

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  • DOI: https://doi.org/10.1007/s00784-019-03017-5

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