AI Article Synopsis
- The study aimed to assess the effectiveness of eight surgical treatments involving maxillomandibular advancement (MMA) for adults with obstructive sleep apnea (OSA).
- After analyzing data from eight studies with 227 patients, the combination of MMA and uvulopalatopharyngoplasty with uvula preservation (MMA + HUPPP) was found to be the most effective treatment.
- Other promising options included MMA combined with counterclockwise maxillomandibular advancement (CMMA) and transoral robotic surgery (MMA + TORS).
Article Abstract
Purpose: To evaluate the efficacy of eight different surgical treatments based on maxillomandibular advancement (MMA), which has emerged in recent years, for adult obstructive sleep apnoea (OSA) patients.
Methods: The literature was searched from January 2010 to May 2020 for studies of adult OSA patients with different types of MMA procedures to perform a network meta-analysis. The outcomes were changes in the apnoea-hypopnoea index (AHI), the lowest pulse oxygen saturation (SpO min) and the Epworth Sleepiness Scale (ESS). Treatment hierarchy was summarized according to the rank charts.
Results: Eight studies were included and encompassed a total of 227 adult patients diagnosed with OSA. Among them, 225 patients underwent combined surgery or simple MMA surgery, including modified maxillomandibular advancement (MMMA),counterclockwise maxillomandibular advancement (CMMA), drug-induced sleep endoscopy and maxillomandibular advancement (MMA + DISE), transoral robotic surgery and maxillomandibular advancement (MMA + TORS), uvulopalatopharyngoplasty (UPPP), maxillomandibular advancement and uvulopalatopharyngoplasty (MMA + UPPP), uvulopalatopharyngoplasty with uvula preservation and maxillomandibular advancement (MMA + HUPPP); MMA consisting of Le Fort I osteotomy and bilateral inverted-L osteotomy (ILOs), genioplasty and iliac bone grafting; and MMA consisting of Le Fort I osteotomy, bilateral sagittal split ramus osteotomies and genioplasty. The results showed that the most effective surgical treatment is MMA + HUPPP [- 56.79 (WMD); 95% confidence interval (CI): - 113.02 to - 3.33] (P < 0.00001), which was far superior to other approaches.
Conclusion: MMA combined with HUPPP had the highest efficacy. The MMA consisted of Le Fort I osteotomy, bilateral sagittal split ramus osteotomies and genioplasty; CMMA and MMA + TORS are likely also great choices.
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| http://dx.doi.org/10.1007/s00405-020-06287-y | DOI Listing |
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