Impact of Maxillomandibular Advancement on Health-Related and Functional Outcomes: The Dalhousie Experience

Abstract

Purpose: To determine the clinical effectiveness and safety of maxillomandibular advancement surgery (MMA) for the treatment of moderate to severe obstructive sleep apnea (OSA).

Methods: A prospective cohort study was designed to evaluate patients undergoing MMA for treatment of moderate to severe OSA with an apnea-hypopnea index (AHI) > 15. Primary outcome measures included 1. Objective measures: AHI, high-sensitivity C-reactive protein (hsCRP), psychomotor vigilance task (PVT) reaction times (1/RT), blood pressure (BP) and body mass index (BMI) and 2. Subjective measures: sleepiness (Epworth Sleepiness Scale [ESS]) and quality of life (Functional Outcomes of Sleep Questionnaire [FOSQ]). Secondary outcome measures included surgical site infections (SSI), neurosensory disturbance and changes in facial appearance.

Results: Nine patients (55.6% men, age 48+6.4 years [mean+SD]) participated in the study with an average of 278.3 days (9.15 months) follow-up. Mean BMI was 30.9+5.95 and mean AHI was 31.14+13.56. AHI decreased from a mean of 31.14+13.56 to 7.12+10.97 events/h (p<0.01). PVT reaction times (1/RT) improved from 2.79+0.32 to 3.04+0.27 (p<0.05). ESS decreased from a mean of 13.22+4.09 to 4.33+3.04 (p<0.01). FOSQ increased from a mean of 13.38+3.2 to 17.8+2.9 (p<0.01). No major peri-operative adverse events were reported. Three post-operative infections were minor and managed with oral antibiotics and irrigation. 88.9% of patients (eight out of nine) felt the change in their facial appearance was either favourable or neutral. 66.7% (four out of six) of patients who experienced post-operative sensory numbness described the numbness as not a problem or a very mild problem. There were no statistically significant changes in hsCRP, BP or BMI.

Conclusion: The results of this study support MMA as being a highly effective surgical option for the treatment of moderate to severe OSA, for patients unable to adhere to CPAP therapy, and caries a low risk of adverse outcomes including numbness and infection.