Maxillomandibular Advancement Surgery for Patients Who Are Refractory to Continuous Positive Airway Pressure: Are There Predictors of Success?

Purpose: This pilot study was conducted to determine the effectiveness of maxillomandibular advancement (MMA) in the treatment of patients with moderate to severe obstructive sleep apnea (OSA). The predictive value of clinical, radiographic, and treatment-related variables also was investigated in relation to the success or failure of MMA as treatment for OSA.

Materials And 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 the University of Michigan (Ann Arbor, MI). Data collected included clinical, radiographic, and polysomnographic findings. Primary outcomes of interest included the AHI, minimal oxygen saturation, and percentage of time spent with oxygen saturation lower than 88% as measured by polysomnography.

Results: Twenty patients met the inclusion criteria for the study (mean age, 48.8 ± 12.3 yr). Mean body mass index decreased from 32.03 ± 5.13 kg/m at baseline to 29.75 ± 5.23 kg/m at follow-up (P = .001). Mean advancements were 13.5 ± 2.7 mm at point B and 16.1 ± 4.5 mm at the pogonion. A 4.5-fold increase in minimal cross-sectional area and a 2.2-fold increase in airway volume were achieved on average. Patients showed a 68.5% decrease in mean AHI from 49.4 to 15.6 events per hour (P < .001). The percentage of time with oxygen saturation lower than 88% was significantly decreased from 15.4% at baseline to 1.4% after surgery (P = .014). The overall surgical success rate was 55% (11 of 20) based on an AHI of fewer than 15 events per hour.

Conclusions: These preliminary results indicate that MMA surgery might be highly effective for select patients with moderate to severe OSA. Despite large increases in airway dimensions, a surgical success rate of 55% was achieved in the overall sample. Assessment of predictive variables for success and failure are discussed.