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Counterclockwise maxillomandibular advancement: a choice for Chinese patients with severe obstructive sleep apnea

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Abstract

Purpose

Maxillomandibular advancement (MMA) is an effective alternative for treating severe obstructive sleep apnea (OSA). However, the promotion of MMA in China is limited by many Chinese patients having a convex facial profile. To achieve maximal upper airway enlargement without an esthetic disaster, we added counterclockwise rotation of the maxillomandibular complex (MMC) in the routine MMA. In this paper, we have evaluated the objective and subjective outcomes of this technology.

Methods

In total, 33 severe OSA patients who accepted counterclockwise maxillomandibular advancement (CMMA) were investigated in this study. Genioplasty, uvulopalatopharyngoplasty (UPPP), and turbinate reduction were also performed on selected patients. Polysomnography (PSG) and Epworth sleepiness scale (ESS) were chosen to evaluate the effectiveness of this technology in treating OSA. Patients’ facial appearances were evaluated by cephalometric analysis and 5-point Likert scales.

Results

After CMMA, the apnea-hypopnea index (AHI) decreased from 59.3 ± 14.6 to 10.2 ± 6.7 (P < 0.001), minimum SpO2 (pulse oxygen saturation, %) increased from 74.0 ± 11.7 to 88.8 ± 4.4 (P < 0.001), and ESS decreased from 12.5 ± 2.3 to 7.3 ± 2.1. It is encouraging that soft-tissue cephalometric measurements such as facial convexity angle, nasolabial angle, and labiomental fold were not worsening after surgery. The Likert scales revealed that 28 patients (85%) were satisfied or very satisfied with their facial changes. In addition, no patient complained about dental function after surgery.

Conclusions

These findings indicate that CMMA is an effective way to achieve a balance between airway enlargement and facial appearance for Chinese patients with severe OSA.

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References

  1. 1.

    Malhotra A, White DP (2002) Obstructive sleep apnoea. Lancet 360:237–245

  2. 2.

    Huang SG, Li QY (2003) Prevalence of obstructive sleep apnea-hypopnea syndrome in Chinese adults aged over 30 yr in Shanghai. Zhonghua jie he he hu xi za zhi= Zhonghua jiehe he huxi zazhi= Chinese journal of tuberculosis and respiratory diseases 26:268–272

  3. 3.

    Aurora RN, Casey KR, Kristo D, Auerbach S et al (2010) Practice parameters for the surgical modifications of the upper airway for obstructive sleep apnea in adults. Sleep 33:1408–1413

  4. 4.

    Zaghi S, Holty J-EC, Certal V, Abdullatif J, Guilleminault C et al (2016) Maxillomandibular advancement for treatment of obstructive sleep apnea: a meta-analysis. JAMA Otolaryngology–Head & Neck Surgery 142:58–66

  5. 5.

    Prinsell JR (2000) Maxillomandibular advancement (MMA) in a site-specific treatment approach for obstructive sleep apnea: a surgical algorithm. Sleep and Breathing 4:147–154

  6. 6.

    Li KK (2011) Maxillomandibular advancement for obstructive sleep apnea. J Oral Maxillofac Surg 69:687–694

  7. 7.

    Brevi BC, Toma L, Pau M, Sesenna E (2011) Counterclockwise rotation of the occlusal plane in the treatment of obstructive sleep apnea syndrome. J Oral Maxillofac Surg 69:917–923

  8. 8.

    Hsieh YJ, Liao YF (2013) Effects of maxillomandibular advancement on the upper airway and surrounding structures in patients with obstructive sleep apnoea: a systematic review. Br J Oral Maxillofac Surg 51:834–840

  9. 9.

    Mehra P, Downie M, Pita MC, Wolford LM (2001) Pharyngeal airway space changes after counterclockwise rotation of the maxillomandibular complex. Am J Orthod Dentofac Orthop 120:154–159

  10. 10.

    Iber C (2007) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. American Academy of Sleep Medicine.

  11. 11.

    Young T, Peppard PE, Gottlieb DJ (2002) Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 165:1217–1239

  12. 12.

    Fairburn SC, Waite PD, Vilos G, Harding SM, Bernreuter W, Cure J, Cherala S (2007) Three-dimensional changes in upper airways of patients with obstructive sleep apnea following maxillomandibular advancement. J Oral Maxillofac Surg 65:6–12

  13. 13.

    Li KK, Guilleminault C, Riley RW, Powell NB (2002) Obstructive sleep apnea and maxillomandibular advancement: an assessment of airway changes using radiographic and nasopharyngoscopic examinations. J Oral Maxillofac Surg 60:526–530

  14. 14.

    Faria AC, da Silva-Junior SN, Garcia LV et al (2013) Volumetric analysis of the pharynx in patients with obstructive sleep apnea (OSA) treated with maxillomandibular advancement (MMA). Sleep and Breathing 17:395–401

  15. 15.

    Faria AC, Garcia LV, Santos AC et al (2016) Dynamic comparison of pharyngeal stability during sleep in patients with obstructive sleep apnea syndrome treated with maxillomandibular advancement. Sleep and Breathing. doi:10.1007/s11325-016-1362-8

  16. 16.

    Liao YF, Chiu YT, Lin CH, Chen YA, Chen NH, Chen YR (2015) Modified maxillomandibular advancement for obstructive sleep apnoea: towards a better outcome for Asians. Int J Oral Maxillofac Surg 44:189–194

  17. 17.

    Goncalves JR, Buschang PH, Goncalves DG, Wolford LM (2006) Postsurgical stability of oropharyngeal airway changes following counter-clockwise maxillo-mandibular advancement surgery. J Oral Maxillofac Surg 64:755–762

  18. 18.

    Li KK (2005) Surgical therapy for adult obstructive sleep apnea. Sleep Med Rev 9:201–209

  19. 19.

    Jaspers GW, Booij A, De Graaf JE, Lange J (2013) Long-term results of maxillomandibular advancement surgery in patients with obstructive sleep apnoea syndrome. Br J Oral Maxillofac Surg 51:e37–e39

  20. 20.

    Segal Y, Malhotra A, Pillar G (2008) Upper airway length may be associated with the severity of obstructive sleep apnea syndrome. Sleep and Breathing 12:311–316

  21. 21.

    Susarla SM, Abramson ZR, Dodson TB, Kaban LB (2011) Upper airway length decreases after maxillomandibular advancement in patients with obstructive sleep apnea. J Oral Maxillofac Surg 69:2872–2878

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Acknowledgments

The authors acknowledge the financial support received from the Science and Technology Commission Foundation of Shanghai Municipality (16140903900).

Author information

Correspondence to Hua Zhang or Xiaofeng Lu.

Ethics declarations

Fund

This study was funded by the Science and Technology Commission Foundation of Shanghai Municipality (16140903900).

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures involving human participants were approved by the Institutional Board of Ethics of the hospital.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Comment

The authors here propose and validate a method to enhance esthetic outcomes after maxillary mandibular advancement surgery for OSA in their specific Asian cohort. The results submitted are highly encouraging and I congratulate the authors on their work.

Soroush Zaghi

CA, USA

Silong Wei and Yong Zhang are co-first author

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Wei, S., Zhang, Y., Guo, X. et al. Counterclockwise maxillomandibular advancement: a choice for Chinese patients with severe obstructive sleep apnea. Sleep Breath 21, 853–860 (2017). https://doi.org/10.1007/s11325-017-1484-7

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Keywords

  • Counterclockwise rotation
  • Maxillomandibular advancement
  • Obstructive sleep apnea
  • Esthetics