ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Maxillomandibular Advancement (MMA) Surgery Is An Effective Second or Third-Line Treatment Modality For Morbidly Obese Patients with Obstructive Sleep Apnea (OSA)
Clinical Question For morbidly obese patients with obstructive sleep apnea, does maxillomandibular advancement surgery, as compared to Continuous Positive Airway Pressure (CPAP), correct the deficiency?
Clinical Bottom Line Maxillomandibular advancement surgery and weight counseling is one treatment alternative for morbidly obese patients with obstructive sleep apnea when other less invasive treatment options are unsuccessful.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 25644497Comacho/ 201534 Morbidly obese patients with obstructive sleep apneaMeta-Analysis
Key resultsMore studies of MMA as treatment for OSA in the morbidly obese are needed to confirm MMA efficacy. However, the limited data available indicates MMA as a successful treatment alternative to CPAP in morbidly obese patients with obstructive sleep apnea. Post-MMA data demonstrated a 89.4% reduction in AHI, a 20.5-point improvement in lowest oxygen saturation, and decreased sleepiness. The MMA surgical success rates were comparable between the morbidly obese (85.3%) and normal BMI patients (86%) but a lower cure rate was observed in the morbidly obese patients (43.2% vs. 26.5%).
#2) 24308097Doff/2013 1 morbidly obese patient with OSA and CPAP intoleranceCase report
Key resultsThe post-surgical apnea-hypopnea index (AHI) was 6, and the lowest oxyhemoglobin saturation level increased to 86% (compared to pre-surgical AHI of 139, and lowest oxyhemoglobin saturation level of 73%). These results suggest that MMA should be considered for morbidly obese, CPAP-intolerant, patients with severe OSA.
Evidence Search Clinical Quaries : morbid obese and sleep apnea and mandibular advancement surgery
Comments on
The Evidence
The current search did not locate any information directly comparing CPAP to MMA in morbidly obese individuals with OSA; there appears to be a lack of direct evidence on the subject. However, the current available research suggests the validity of MMA surgery as a viable alternative treatment in cases where CPAP is ineffective. Validity: Both articles have low validity (low evidence hierarchy). The Comacho article summarized data based on information collected from inadequate sample sizes (34 total) and the Doff article is a case study of a single patient. Multiple case reports and or case series will help to verify these conclusions and validate clinical efficacy of MMA in obese patients and also produce more clear selection criteria to assist practitioners in patient selection.
Applicability Potential patient harm can result from non-comprehensive patient screening. MMA should not be a practitioner’s first automatic treatment option for morbidly obese patients with OSA. Patients should be evaluated with other less invasive treatment alternatives such as CPAP, or mandibular repositioning devices before consideration of MMA surgery. Risk benefit models should be utilized in decision making because, for those cases where MMA in indicated, the procedure appears efficacious.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Orthodontics) (Basic Science)
Keywords maxillomandibular advancement; morbid obesity; obstructive sleep apnea; sleep apnea syndromes
ID# 2929
Date of submission: 11/03/2015spacer
E-mail Russelldk@uthscsa.edu
Author Deborah Russell, DDS
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Ravikumar Anthony, BDS, MDS, MS
Faculty mentor/Co-author e-mail ANTHONYR@uthscsa.edu
Basic Science Rationale
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