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Orthognathic surgery for obstructive sleep apnea

  • Joseph E. Cillo Jr.
    Correspondence
    Corresponding author.
    Affiliations
    Division of Oral and Maxillofacial Surgery, 320 East North Avenue, Suite 6100 South Tower, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA 15212, United States
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  • David J. Dattilo
    Affiliations
    Division of Oral and Maxillofacial Surgery, 320 East North Avenue, Suite 6100 South Tower, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA 15212, United States
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Published:August 13, 2019DOI:https://doi.org/10.1053/j.sodo.2019.08.003

      Abstract

      As the importance in the management of obstructive sleep apnea and other obstructive upper airway disease continues to increase, the effect of orthognathic surgery on the upper airway in correction of both dentofacial deformities and obstructive sleep apnea has become a prominent component of treatment planning in recent decades. Applied correctly, orthognathic surgery can have a dramatic and life-changing effect on decreasing nocturnal obstructions through expansion of the upper airway. Large advancements of the maxillomandibular complex allows for three-dimensional upper airway expansion to nocturnal obstruction that diminish the deleterious effects of obstructive sleep apnea. This paper will discuss the orthognathic surgical techniques that are essential in the treatment planning to achieve the desired results of relief of nocturnal upper airway obstructions.
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      References

        • White D.P.
        Advanced concepts in the pathophysiology of obstructive sleep apnea.
        Adv Otorhinolaryngol. 2017; 80: 7-16https://doi.org/10.1159/000470522
        • Dempsey J.A.
        • Xie A.
        • Patz D.S.
        • Wang D.
        Physiology in medicine: obstructive sleep apnea pathogenesis and treatment–considerations beyond airway anatomy.
        J Appl Physiol. 2014; 116 (1): 3-12https://doi.org/10.1152/japplphysiol.01054.2013
        • Costa E.
        • Sousa R.A.
        • dos Santos Gil N.A.
        Craniofacial skeletal architecture and obstructive sleep apnea syndrome severity.
        J Craniomaxillofac Surg. 2013; 41: 740-746https://doi.org/10.1016/j.jcms.2012.12.010
        • Riley R.W.
        • Powell N.B.
        • Li K.K.
        • et al.
        Surgery and obstructive sleep apnea: long-term clinical outcomes.
        Otolaryngol Head Neck Surg. 2000; 122: 415
        • Holty J.E.
        • Guilleminault C.
        Maxillomandibular advancement for the treatment of obstructive sleep apnea: a systematic review and meta-analysis.
        Sleep Med Rev. 2010; 14: 287
        • Sakakibara H.
        • Tong M.
        • Matsushita K.
        • Hirata M.
        • Konishi Y.
        • Suetsugu S.
        Cephalometric abnormalities in non-obese and obese patients with obstructive sleep apnea.
        Eur Respir J. 1999; 13: 403-410
        • Zaghi S.
        • Holty J.E.
        • Certal V.
        • et al.
        Maxillomandibular advancement for treatment of obstructive sleep apnea: a meta-analysis.
        JAMA Otolaryngol Head Neck Surg. 2016; 142: 58-66https://doi.org/10.1001/jamaoto.2015.2678
        • Agha B.
        • Johal A.
        Facial phenotype in obstructive sleep apnea-hypopnea syndrome: a systematic review and meta-analysis.
        J Sleep Res. 2017; 26: 122-131https://doi.org/10.1111/jsr.12485
        • Mattos C.T.
        • Vilani G.N.
        • Sant'Anna E.F.
        • Ruellas A.C.
        • Maia L.C.
        Effects of orthognathic surgery on oropharyngeal airway: a meta-analysis.
        Int J Oral Maxillofac Surg. 2011; 40: 1347-1356https://doi.org/10.1016/j.ijom.2011.06.020
        • Huon L.K.
        • Liu S.Y.
        • Shih T.T.
        • Chen Y.J.
        • Lo M.T.
        • Wang P.C.
        Dynamic upper airway collapse observed from sleep MRI: BMI-matched severe and mild OSA patients.
        Eur Arch Otorhinolaryngol. 2016; 273: 4021-4026
        • Liu S.Y.
        • Huon L.K.
        • Lo M.T.
        • et al.
        Static craniofacial measurements and dynamic airway collapse patterns associated with severe obstructive sleep apnea: a sleep MRI study.
        Clin Otolaryngol. 2016; 41: 700-706https://doi.org/10.1111/coa.12598
        • Barrera J.E.
        Sleep magnetic resonance imaging: dynamic characteristics of the airway during sleep in obstructive sleep apnea syndrome.
        Laryngoscope. 2011; 121: 1327-1335https://doi.org/10.1002/lary.21810
        • Kezirian E.J.
        • Hohenhorst W.
        • de Vries N.
        Drug-induced sleep endoscopy: the VOTE classification.
        Eur Arch Otorhinolaryngol. 2011; 268: 1233-1236https://doi.org/10.1007/s00405-011-1633-8
        • Butterfield K.J.
        • Marks P.L.
        • McLean L.
        • Newton J.
        Quality of life assessment after maxillomandibular advancement surgery for obstructive sleep apnea.
        J Oral Maxillofac Surg. 2016; 74: 1228-1237https://doi.org/10.1016/j.joms.2016.01.043
        • Abramson Z.
        • Susarla S.
        • August M.
        • Troulis M.
        • Kaban L.
        Three-dimensional computed tomographic analysis of airway anatomy in patients with obstructive sleep apnea.
        J Oral Maxillofac Surg. 2010; 68: 354-362https://doi.org/10.1016/j.joms.2009.09.087
        • Tangugsorn V.
        • Skatvedt O.
        • Krogstad O.
        • Lyberg T.
        Obstructive sleep apnea: a cephalometric study. part I. Cervico-craniofacial skeletal morphology.
        Eur J Orthod. 1995; 17: 45-56
        • Rosario H.D.
        • Oliveira G.M.S.
        • Freires I.A.
        • de Souza Matos F.
        • Paranhos L.R.
        Efficiency of bimaxillary advancement surgery in increasing the volume of the upper airways: a systematic review of observational studies and meta-analysis.
        Eur Arch Otorhinolaryngol. 2017; 274: 35-44https://doi.org/10.1007/s00405-016-4015-4
        • Hwang S.
        • Chung C.J.
        • Choi Y.J.
        • Huh J.K.
        • Kim K.H.
        Changes of hyoid, tongue and pharyngeal airway after mandibular setback surgery by intraoral vertical ramus osteotomy.
        Angle Orthod. 2010; 80: 302-308https://doi.org/10.2319/040209-188.1
        • Hochban W.
        • Schürmann R.
        • Brandenburg U.
        • Conradt R.
        Mandibular setback for surgical correction of mandibular hyperplasia–does it provoke sleep-related breathing disorders?.
        Int J Oral Maxillofac Surg. 1996; 25: 333-338
        • He J.
        • Wang Y.
        • Hu H.
        • et al.
        Impact on the upper airway space of different types of orthognathic surgery for the correction of skeletal Class III malocclusion: a systematic review and meta-analysis.
        Int J Surg. 2017; 38: 31-40https://doi.org/10.1016/j.ijsu.2016.12.033
        • Chen F.
        • Terada K.
        • Hua Y.
        • Saito I.
        Effects of bimaxillary surgery and mandibular setback surgery on pharyngeal airway measurements in patients with Class III skeletal deformities.
        Am J Orthod Dentofacial Orthop. 2007; 131: 372-377
        • Degerliyurt K.
        • Ueki K.
        • Hashiba Y.
        • Marukawa K.
        • Nakagawa K.
        • Yamamoto E.
        A comparative CT evaluation of pharyngeal airway changes in Class III patients receiving bimaxillary surgery or mandibular setback surgery.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008; 105: 495-502https://doi.org/10.1016/j.tripleo.2007.11.012
        • Kitagawara K.
        • Kobayashi T.
        • Goto H.
        • Yokobayashi T.
        • Kitamura N.
        • Saito C.
        Effects of mandibular setback surgery on oropharyngeal airway and arterial oxygen saturation.
        Int J Oral Maxillofac Surg. 2008; 37: 328-333https://doi.org/10.1016/j.ijom.2007.12.005
        • Lye K.W.
        Effect of orthognathic surgery on the posterior airway space (PAS).
        Ann Acad Med Singapore. 2008; 37: 677-682
        • Tan S.K.
        • Leung W.K.
        • Tang A.T.H.
        • Zwahlen R.A.
        Effects of mandibular setback with or without maxillary advancement osteotomies on pharyngeal airways: an overview of systematic reviews.
        PLoS ONE. 2017; 12e0185951https://doi.org/10.1371/journal.pone.0185951
        • Foltan R.
        • Rybinova K.
        The impact of mandibular advancement on the upper airway patterns–cephalometric study.
        Prague Med Rep. 2007; 108: 147-154
        • Achilleos S.
        • Krogstad O.
        • Lyberg T.
        Surgical mandibular advancement and changes in uvuloglossopharyngeal morphology and head posture: a short- and long-term cephalometric study in males.
        Eur J Orthod. 2000; 22: 367-381
        • Hoshijima M.
        • Honjo T.
        • Moritani N.
        • Iida S.
        • Yamashiro T.
        • Kamioka H.
        Maxillary advancement for unilateral crossbite in a patient with sleep apnea syndrome.
        Acta Med Okayama. 2015; 69: 177-182
        • Vijayakumar Jain S.
        • Muthusekhar M.R.
        • Baig M.F.
        • et al.
        Evaluation of three-dimensional changes in pharyngeal airway following isolated lefort one osteotomy for the correction of vertical maxillary excess: a prospective study.
        J Maxillofac Oral Surg. 2019; 18: 139-146https://doi.org/10.1007/s12663-018-1113-4
        • Waite P.D.
        • Wooten V.
        • Lachner J.
        • Guyette R.F.
        Maxillomandibular advancement surgery in 23 patients with obstructive sleep apnea syndrome.
        J Oral Maxillofac Surg. 1989; 47: 1256-1261
        • Prinsell J.R.
        Maxillomandibular advancement surgery in a site-specific treatment approach for obstructive sleep apnea in 50 consecutive patients.
        Chest. 1999; 116: 1519-1529
        • Boyd S.B.
        Management of obstructive sleep apnea by maxillomandibular advancement.
        Oral Maxillofac Surg Clin North Am. 2009; 21: 447-457https://doi.org/10.1016/j.coms.2009.09.001
        • Caples S.M.
        • Rowley J.A.
        • Prinsell J.R.
        • et al.
        Surgical modifications of the upper airway for obstructive sleep apnea in adults: a systematic review and meta-analysis.
        Sleep. 2010; 33: 1396-1407
        • Boyd S.B.
        • Walters A.S.
        • Waite P.
        • Harding S.M.
        • Song Y.
        Long-Term effectiveness and safety of maxillomandibular advancement for treatment of obstructive sleep apnea.
        J Clin Sleep Med. 2015; 11: 699-708https://doi.org/10.5664/jcsm.4838
        • Boyd S.B.
        • Chigurupati R.
        • Cillo Jr., J.E.
        • et al.
        Maxillomandibular advancement improves multiple health-related and functional outcomes in patients with obstructive sleep apnea: a multicenter study.
        J Oral Maxillofac Surg. 2019; 77: 352-370https://doi.org/10.1016/j.joms.2018.06.173
        • Schendel S.A.
        • Broujerdi J.A.
        • Jacobson R.L.
        Three-dimensional upper-airway changes with maxillomandibular advancement for obstructive sleep apnea treatment.
        Am J Orthod Dentofac Orthop. 2014; 146: 385-393
        • Butterfield K.J.
        • Marks P.L.
        • McLean L.
        • Newton J.
        Linear and volumetric airway changes after maxillomandibular advancement for obstructive sleep apnea.
        J Oral Maxillofac Surg. 2015; 73: 1133-1142https://doi.org/10.1016/j.joms.2014.11.020
        • Sittitavornwong S.
        • Waite P.D.
        • Shih A.M.
        • et al.
        Computational fluid dynamic analysis of the posterior airway space after maxillomandibular advancement for obstructive sleep apnea syndrome.
        J Oral Maxillofac Surg. 2013; 71: 1397-1405https://doi.org/10.1016/j.joms.2013.02.022
        • Hsieh Y.J.
        • Liao Y.F.
        Effects of maxillomandibular advancement on the upper airway and surrounding structures in patients with obstructive sleep apnea: a systematic review.
        Br J Oral Maxillofac Surg. 2013; 51: 834-840https://doi.org/10.1016/j.bjoms.2012.11.010
        • Susarla S.M.
        • Abramson Z.R.
        • Dodson T.B.
        • Kaban L.B.
        Upper airway length decreases after maxillomandibular advancement in patients with obstructive sleep apnea.
        J Oral Maxillofac Surg. 2011; 69: 2872-2878https://doi.org/10.1016/j.joms.2011.01.005
        • Maganzini A.L.
        • Alhussain I.Y.
        Treatment of obstructive sleep apnea with combined orthognathic-orthodontic approach assessed by nocturnal polysomnography.
        N Y State Dent J. 2008; 74: 36-40
        • Torres H.M.
        • Valladares-Neto J.
        • Torres A.M.
        • Freitas R.Z.
        • Silva M.A.
        Effect of genioplasty on the pharyngeal airway space following maxillomandibular advancement surgery.
        J Oral Maxillofac Surg. 2017; 75 (e1-189.e12): 189https://doi.org/10.1016/j.joms.2016.09.005
        • Dattilo D.J.
        • Drooger S.A.
        Outcome assessment of patients undergoing maxillofacial procedures for the treatment of sleep apnea: comparison of subjective and objective results.
        J Oral Maxillofac Surg. 2004; 62: 164-168
        • Goodday R.H.
        • Bourque S.E.
        • Edwards P.B.
        Objective and subjective outcomes following maxillomandibular advancement surgery for treatment of patients with extremely severe obstructive sleep apnea (Apnea-Hypopnea Index >100).
        J Oral Maxillofac Surg. 2016; 74: 583-589https://doi.org/10.1016/j.joms.2015.07.016
        • John C.R.
        • Gandhi S.
        • Sakharia A.R.
        • James T.T.
        Maxillomandibular advancement is a successful treatment for obstructive sleep apnea: a systematic review and meta-analysis.
        Int J Oral Maxillofac Surg. 2018; 47: 1561-1571https://doi.org/10.1016/j.ijom.2018.05.015
        • de Ruiter M.H.T.
        • Apperloo R.C.
        • Milstein D.M.J.
        • de Lange J.
        Assessment of obstructive sleep apnea treatment success or failure after maxillomandibular advancement.
        Int J Oral Maxillofac Surg. 2017; 46: 1357-1362https://doi.org/10.1016/j.ijom.2017.06.006
        • Giarda M.
        • Brucoli M.
        • Arcuri F.
        • Benech R.
        • Braghiroli A.
        • Benech A.
        Efficacy and safety of maxillomandibular advancement in treatment of obstructive sleep apnea syndrome.
        Acta Otorhinolaryngol Ital. 2013; 33: 43-46
        • Aurora R.N.
        • Casey K.R.
        • Kristo D.
        • et al.
        Practice parameters for the surgical modifications of the upper airway for obstructive sleep apnea in adults.
        Sleep. 2010; 33: 1408-1413
        • Boyd S.B.
        • Walters A.S.
        • Song Y.
        • Wang L.
        Comparative effectiveness of maxillomandibular advancement and uvulopalatopharyngoplasty for the treatment of moderate to severe obstructive sleep apnea.
        J Oral Maxillofac Surg. 2013; 71: 743-751https://doi.org/10.1016/j.joms.2012.10.003
        • Nimkarn Y.
        • Miles P.G.
        • Waite P.D.
        Maxillomandibular advancement surgery in obstructive sleep apnea syndrome patients: long-term surgical stability.
        J Oral Maxillofac Surg. 1995; 53: 1414-1486
        • Lee S.H.
        • Kaban L.B.
        • Lahey E.T.
        Skeletal stability of patients undergoing maxillomandibular advancement for treatment of obstructive sleep apnea.
        J Oral Maxillofac Surg. 2015; 73: 694-700https://doi.org/10.1016/j.joms.2014.10.018
        • Cillo Jr, J.E.
        • Dattilo D.J.
        Maxillomandibular advancement for severe obstructive sleep apnea is a highly skeletally stable long-term procedure.
        J Oral Maxillofac Surg. 2019; (pii: S0278-2391(19)30012-6)https://doi.org/10.1016/j.joms.2019.01.009
        • Conley R.S.
        • Boyd S.B.
        Facial soft tissue changes following maxillomandibular advancement for treatment of obstructive sleep apnea.
        J Oral Maxillofac Surg. 2007; 65: 1332-1340
        • Li K.K.
        • Riley R.W.
        • Powell N.B.
        • Guilleminault C.
        Patient's perception of the facial appearance after maxillomandibular advancement for obstructive sleep apnea syndrome.
        J Oral Maxillofac Surg. 2001; 59: 377-380
        • Farrell B.B.
        • Tucker M.R.
        Safe, efficient, and cost-effective orthognathic surgery in the outpatient setting.
        J Oral Maxillofac Surg. 2009; 67: 2064-2071https://doi.org/10.1016/j.joms.2009.04.096
        • Cillo Jr., J.E.
        • Dattilo D.J.
        Early major medical complications after surgical management of obstructive sleep apnea: a retrospective cohort analysis and case series.
        J Oral Maxillofac Surg. 2015; 73: 123-128https://doi.org/10.1016/j.joms.2014.07.023