Maxillomandibular Advancement for Severe Obstructive Sleep Apnea is a Highly Skeletally Stable Long-term Procedure.

Publication date: Available online 14 January 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Joseph E. Cillo, David J. Dattilo

ABSTRACT

Purpose

Evaluate the long-term clinically significant cephalometric skeletal stability with maxillomandibular advancement (MMA) for obstructive sleep apnea (OSA).

Methods

This was a retrospective cohort analysis of long-term clinically significant skeletal stability of subjects who had MMA for OSA. The primary predictor and outcome variables were occurrence of and time-to-loss of clinically significant skeletal stability at SNB, respectively. Inclusion criteria included severe OSA (AHI > 30), MMA, diagnostic pre- and post-operative lateral cephalometric radiographs, and a minimum of 5 years of follow-up. Digitized cephalometric radiographs were analyzed at 3 time points – pre-operative (T0), post-operative (T1) and last follow-up (T2).

Statistical analyses included Kaplan Meier time-to-loss of clinical stability analysis, log rank test, and Cox's proportional hazards model for Hazard Ratio (HR) determination for the influence of independent variable sex, age at time of surgery, time to follow-up and amount of surgical movement on loss of clinical stability. Post-hoc stratification for bone grafting was completed. Statistical significance was set at the P < .05 level.

Results

Thirty consecutive subjects with an even sex distribution and average follow-up of 10.7 were included in this study. Pre-operative averages for age was 43.7, for AHI was 59.8, and for BMI was 39.3.

Half of the cohort had clinically significant loss of skeletal stability in SNA, SNB, and ANB approximately 13 years after surgery with no statistically significant difference between SNA, SNB, and ANB curves (χ² = 0.12) independent of independent variables at SNB (χ² = 1.9), SNA (χ² = 1.3), or ANB (χ² = 1.3). Average HR ranged from 0.89 to 1.02.

Conclusion

Within the limitations of this study, MMA in the treatment of severe OSA is a highly skeletally stable long-term procedure independent of sex, age at time of surgery, time to follow-up and amount of surgical movement.

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