ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Treatment of Obstructive Sleep Apnea with Maxillomandibular Advancement Surgery Results in a Reduction of the Apnea Hypopnea Index
Clinical Question In adult patients with obstructive sleep apnea (OSA), does maxillomandibular advancement (MMA) result in a reduction in the apnea hypopnea index (AHI)?
Clinical Bottom Line Maxillomandibular advancement surgery results in a reduction of the apnea hypopnea index and is a viable treatment option for obstructive sleep apnea.
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) 20189852Holty/2010Adults- 53 reports, 627 adults with OSASystematic Review with Meta Analysis
Key resultsThe mean apnea-hypopnea index (AHI) decreased from 63.9/h to 9.5/h (p<0.001) due to MMA surgery. Patients that demonstrated surgical success included those of a younger age, lower preoperative weight and AHI and a greater degree of maxillary advancement achieved. This review concluded that MMA is a safe and effective treatment for MMA.
#2) 21855196Prinsell/2012Adults with OSALiterature Review
Key resultsThis review analyzed several types of maxillomandibular surgery, including primary and secondary maxillomandibular advancement (MMA), with and without intrapharyngeal or extra pharyngeal adjunctive procedures. Mean percent reduction in AHI ranged from 79.4% to 92.1% for the different types of surgery.
#3) 21061863Caples/2010Adults with OSA- 75 case series about different treatments for OSA- 9 related to MMA and 31 multi-approach surgerySystematic Review with Meta Analysis
Key resultsAfter primary MMA surgery, there was an overall reduction in AHI of 87% (95% CI 80% to 92%) with a mean postoperative AHI of 7.7
Evidence Search "Sleep Apnea, Obstructive/surgery"[Majr] AND maxillomandibular advancement AND apnea hypopnea index
Comments on
The Evidence
Although the highest levels of evidence found were systematic reviews with meta analysis and a literature review, these reviews did not include randomized control trials. Most of the studies reviewed were cohorts or case series. Acceptable study designs included randomized and non-randomized control trials, cohort studies and case series. Insufficient randomized control trials exist on this subject. Including randomized control trials in the reviews would increase the strength of evidence. The systematic review by Holty included a meta-analysis and a p value showing a statistically significant reduction in the incidence of apnea or hypopnea per hour. A comprehensive algorithm of standardized weighted outcome parameters to define long-term success of treatment apnea does not exist. Therefore, the AHI is the best objective measure of treatment efficacy at this time. MMA has been shown to reduce the AHI.
Applicability Treatment of OSA with MMA would need to be completed by an oral maxillofacial surgeon. This surgery is indicated when someone cannot or will not tolerate continuous positive airway pressure (CPAP) or when conservative therapies are unsuccessful. Surgery may be considered a first line of treatment for patients with an underlying surgically correctable abnormality. Risks include changes in facial appearance, neurosensory deficit, minor occlusal changes treated with equilibration, infection and temporomandibular disorder. These studies reviewed did not report any deaths due to the surgery. Most patients treated with MMA report improvements in quality of life measures and most OSA symptomatology.
Specialty/Discipline (General Dentistry) (Oral Surgery)
Keywords Obstructive sleep apnea, maxillomandibular advancement, apnea hypopnea index
ID# 2371
Date of submission: 02/21/2013spacer
E-mail lindskog@livemail.uthscsa.edu
Author Hanna Lindskog
Co-author(s) Ann Sue von Gonten, DDS
Co-author(s) e-mail avongonten@gmail.com
Faculty mentor/Co-author
Faculty mentor/Co-author e-mail
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Ryushiro Sugita, DDS (San Antonio, Texas) on 11/17/2015
A PubMed search on the maxillomandibular advancement surgery for OSA was performed Oct 2015. A more recent publication was found: Camacho 2015, PubMed: 25644497. The meta-analysis including 5 clinical studies showed that the pre- and post-maxillomandibular advancement surgery means ± SDs for apnea-hypopnea indices were 86.18 ± 33.25/h and 9.16 ± 7.89/h (P < .00001), and lowest oxygen saturations were 66.58% ± 16.41% and 87.03% ± 5.90% (P < .00001), respectively. However, meta-analysis only included 33 subjects and the level of evidence from those studies is limited.
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