Volumetric Airway Analysis Following Maxillomandibular Advancement For the Treatment of Obstructive Sleep Apnea

Abstract

Purpose: The aim of this study was to quantify pharyngeal airway changes in patients undergoing MMA surgery and determine if there was a relationship between airway parameters and sleep parameters. Methods and Materials: Patients undergoing MMA for the treatment of moderate to severe OSA between October 2014 and January 2018 were included in this prospective study. Patients underwent both a standardized CBCT of their upper airway and polysomnography preoperatively and a minimum of 6 months postoperatively. The preoperative and postoperative DICOM files were processed using Dolphin 11.8 for airway analysis using a standardized protocol to measure the retropalatal and retroglossal regions. Data was collected on airway volume, minimum axial cross-sectional area, AHI, and ESS both preoperatively and post-operatively. A student paired t-test was used to look at the effect of surgical intervention on the airway parameters and sleep parameters and a Pearson bivariate analysis was used to assess for a relationship between airway parameters and sleep parameters. Results: 30 patients had preoperative and postoperative CBCT imaging of their airway, and 22 patients underwent postoperative polysomnography. There were statistically significant increases in airway volume (75%) and minCSA (145%) with MMA surgery. The airway increased in both the lateral (5.1 mm) and AP (3.2 mm) dimension, with a decrease in LAT/AP dimension, which is associated with a change to a rounder airway. 82% of patients experienced surgical success and 50% of patients experienced surgical cure. The magnitude of the increases in airway parameters following MMA surgery did not correlate to decreases in the sleep parameters. However, the magnitude of mandibular advancement was correlated to both increases in the minCSA as well as decreases in the AHI following surgery. Conclusion: Maxillomandibular advancement surgery is a successful procedure that results in statistically significant increases in measured airway parameters and improvement in sleep parameters.