0567 Treatment of Obstructive Sleep Apnea with Maxillomandibular Advancement Surgery: Evaluation and Predictors of Success

Abstract

Introduction: Obstructive sleep apnea (OSA) is a well-recognized disease entity affecting approximately 2% to 4% of the population. Maxillomandibular advancement (MMA) surgery is a highly successful surgical alternative to poorly tolerated CPAP therapy and achieves a success rate of 89% in the current literature. Our present study evaluates the effectiveness of MMA surgery in the treatment of patients with moderate to severe OSA based on Shers criteria of 50% reduction in AHI and AHI < 20. Radiographic and clinical treatment variables were evaluated in determining predictors of success for MMA in individuals with OSA. Methods: A retrospective study design was used to assess the outcomes of MMA in patients with moderate to severe OSA (apnea hypopnea index [AHI] >15 events per hour) at Thomas Jefferson University Hospital. Data collected included clinical, radiographic, and polysomnographic findings. Primary outcomes of interest included AHI and minimum oxygen saturation. Results: Twenty six patients met the inclusion criteria (mean age 50.33 ± 9.7 yr). A 4-fold increase in minimal cross-sectional area was achieved post-surgically. Patients showed a 91% decrease in mean AHI from 59.86 ± 25.2 to 5.06 ± 3.1 events per hour (P < .001). Minimum oxygen saturation increased from a mean of 80.58 ± 9.6 to 86.23 ± 4.6 post-surgically. The overall surgical success was 89% (24 of 26) based on an AHI of fewer than 20 events per hour and a decrease by 50% or more compared to baseline. Preoperative BMI, minimum oxygen saturation, and measured changes in posterior airway space were not statistically different between success and failure groups. Patients who achieved a successful outcome had significantly shorter cephalometrically established Pogonion-C3 and Cross Sectional Airway (CSD) compared to those who did not (84.81 ± 6.7mm vs 96.74 + 7.16mm, 91.02 ± 28.3mm2 vs 39.94 ± 9.7mm2). Conclusion: Maxillomandibular advancement surgery is a highly effective treatment option in patients with moderate to severe OSA achieving a success of 89% in our overall sample. Pogonion-C3 and CSD successfully predicted postoperative success. The lack of association between BMI, PAS and minimum oxygen saturation supports that OSA is a disease entity with a multifactorial etiology.