scholarly journals Effects of maxillomandibular advancement surgery on a skeletal Class III patient with obstructive sleep apnea: A case report

2021 ◽  
Vol 11 ◽  
pp. 161-168
Author(s):  
Ghaddy AlSaty ◽  
Mary Burns ◽  
Peter Ngan
Keyword(s):  
Obstructive Sleep Apnea ◽  
Case Report ◽  
Sleep Apnea ◽  
Definitive Treatment ◽  
Radiographic Examination ◽  
Apnea Hypopnea Index ◽  
Class Iii ◽  
Lateral Cephalogram ◽  
Maxillomandibular Advancement ◽  
Obstructive Sleep

This case report describes the successful surgical treatment of a patient diagnosed with obstructive sleep apnea (OSA). A 55-year-old Caucasian male patient with a body mass index (BMI) of 25.6 kg/m2 sought treatment with a chief concern of excessive daytime sleepiness and fatigue. An initial polysomnography report showed moderate OSA with an apnea-hypopnea index (AHI) of 21.2 events/h, and Epworth Sleepiness Score (ESS) of 12/24. The patient was initially prescribed with CPAP treatment but was unable to tolerate treatment after a few months. Clinical and radiographic examination revealed a concave facial profile with maxillary retrognathism. Intraoral examination revealed generalized gingival recession, missing upper lateral incisors and lower first premolars, anterior crossbite, and maxillary transverse deficiency with bilateral posterior crossbite. The lateral cephalogram showed a narrow posterior airway space at the level of the base of the tongue. The patient was treated with maxillomandibular advancement (MMA) surgery to improve airway obstruction. Results showed balanced facial esthetic and stable occlusion with a complete resolution of the patient’s OSA and a post-operative improvement of AHI from 21.2 to 0.7 events/h and ESS from 12/24 to 3/24. The lowest oxyhemoglobin saturation during sleep was improved to 97%, and the BMI decreased from 25.6 to 25.2 kg/m2. These results suggest that MMA surgical procedure can be used as a definitive treatment for patients with maxillomandibular deficiency and OSA.

Long-term Results for Maxillomandibular Advancement to Treat Obstructive Sleep Apnea: A Meta-analysis

2019 ◽  
Vol 160 (4) ◽  
pp. 580-593 ◽  
Author(s):  
Macario Camacho ◽  
Michael W. Noller ◽  
Michael Del Do ◽  
Justin M. Wei ◽  
Christopher J. Gouveia ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Oxygen Saturation ◽  
Long Term Results ◽  
Cochrane Library ◽  
Apnea Hypopnea Index ◽  
International Literature ◽  
Maxillomandibular Advancement ◽  
Obstructive Sleep

Objective To examine outcomes in the intermediate term (1 to <4 years), long term (4 to <8 years), and very long term (≥8 years) for maxillomandibular advancement (MMA) as treatment for obstructive sleep apnea (OSA). Data Sources The Cochrane Library, Google Scholar, Embase, Cumulative Index to Nursing and Allied Health, and PubMed/MEDLINE. Review Methods Three authors systematically reviewed the international literature through July 26, 2018. Results A total of 445 studies were screened, and 6 met criteria (120 patients). Thirty-one patients showed a reduction in apnea-hypopnea index (AHI) from a mean 48.3 events/h (95% CI, 42.1-54.5) pre-MMA to 8.4 (95% CI 5.6, 11.2) in the intermediate term. Fifty-four patients showed a reduction in AHI from a mean 65.8 events/h (95% CI, 58.8-72.8) pre-MMA to 7.7 (95% CI 5.9, 9.5) in the long term. Thirty-five showed a reduction in AHI from a mean 53.2 events/h (95% CI 45, 61.4) pre-MMA to 23.1 (95% CI 16.3, 29.9) in the very long term. Improvement in sleepiness was maintained at all follow-up periods. Lowest oxygen saturation improvement was maintained in the long term. Conclusion The current international literature shows that patients with OSA who were treated with MMA maintained improvements in AHI, sleepiness, and lowest oxygen saturation in the long term; however, the mean AHI increased to moderate OSA in the very long term. Definitive generalizations cannot be made, and additional research providing individual patient data for the intermediate term, long term, and very long term is needed.

MAXILLOMANDIBULAR ADVANCEMENT IN THE TREATMENT OF SEVERE OBSTRUCTIVE SLEEP APNEA HYPOPNEA SYNDROME: A CASE REPORT

2020 ◽  
Vol 130 (3) ◽  
pp. e167
Author(s):  
MARK JON SANTANA SABEY ◽  
FÁBIO RICARDO LOUREIRO SATO ◽  
DANILO DE PAULA RIBEIRO BORGES ◽  
MARCOS ANTÔNIO LIMA DOS SANTOS ◽  
LUCAS CELESTINO GUERZET AYRES ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Case Report ◽  
Sleep Apnea ◽  
Severe Obstructive Sleep Apnea ◽  
Maxillomandibular Advancement ◽  
Obstructive Sleep ◽  
Hypopnea Syndrome

Polysomnographic Outcomes Before and After Skeletal Surgeries for the Treatment of Obstructive Sleep Apnea

2021 ◽  
Vol 104 (3) ◽  
pp. 445-452
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Apnea Hypopnea Index ◽  
Success Rates ◽  
Maxillomandibular Advancement ◽  
Obstructive Sleep ◽  
Before And After ◽  
Hyoid Suspension ◽  
Group 2 ◽  
Osa Treatment

Objective: To evaluate polysomnographic (PSG) outcomes after common skeletal surgeries for the treatment of obstructive sleep apnea (OSA) in Thai patients. Materials and Methods: The retrospective study included OSA patients aged 18 years and older treated by hyoid suspension (HS) plus uvulopalatopharyngoplasty (UPPP) (Group 1), genioglossus advancement (GA) plus tongue base radiofrequency (TBRF) (Group 2), and maxillomandibular advancement (MMA) (Group 3) at Siriraj Hospital between January 2007 and October 2018. Those with incomplete PSG data were excluded. The primary outcome was the apnea-hypopnea index (AHI). Secondary outcomes were other PSG parameters and postoperative complications. Results: Twenty-four patients including 22 males and 2 females were included. Group1 (n=11), median AHI decreased from 45.4 to 24.1 events/hour (p=0.17), while lowest oxygen saturation (LSAT) changed from 72.0% to 71.0% (p=0.11). Group2 (n=3) median AHI decreased from 64.7 to 51.4 events/hour (p=0.11), LSAT increased from 76.0% to 79.0% (p=1.0), and rapid eye movement (REM) sleep increased from 0.0% to 12.4% (p=0.11). Group3 (n=12) median AHI decreased from 68.5 to 7.8 events/hour (p<0.002), LSAT increased from 75.5% to 88.0% (p=0.04), and REM increased from 0.0% to 21.5% (p=0.01). Surgical success rates as defined by Sher’s criteria or a postoperative AHI of less than five events/hour were 44.4%, 33.3%, and 66.6% in patients in groups 1, 2, and 3, respectively. Common surgical complications included bleeding, mental or perioral paresthesia, and malocclusion after MMA. Conclusion: The skeletal surgeries significantly improved some PSG parameters, and thus may be viable options for OSA treatment in Thai patients. Keywords: Obstructive sleep apnea, Skeletal surgery, Hyoid suspension, Genioglossus advancement, Maxillomandibular advancement, Thai

scholarly journals Correlation of Lateral Cephalogram and Flexible Laryngoscopy with Sleep Study in Obstructive Sleep Apnea

2015 ◽  
Vol 2015 ◽  
pp. 1-7
Author(s):  
Anila Narayanan ◽  
Bini Faizal
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Screening Tools ◽  
Definitive Treatment ◽  
Outpatient Basis ◽  
Lateral Cephalogram ◽  
Sleep Study ◽  
Flexible Laryngoscopy ◽  
Obstructive Sleep ◽  
Lateral Cephalometry

Objective. To study the correlation between lateral cephalogram, flexible laryngoscopy, and sleep study in patients diagnosed with obstructive sleep apnea (OSA).Background. Screening tools should be devised for predicting OSA which could be performed on an outpatient basis. With this aim we studied the skeletal and soft tissue characteristics of proven OSA patients.Methods. A prospective study was performed in patients diagnosed with obstructive sleep apnea by sleep study. They were evaluated clinically and subjected to lateral cephalometry and nasopharyngolaryngoscopy. The findings were matched to see if they corresponded to AHI of sleep study in severity. An attempt was made to see whether the data predicted the patients who would benefit from oral appliance or surgery as the definitive treatment in indicated cases.Results. A retropalatal collapse seen on endoscopy could be equated to the distance from mandibular plane to hyoid (MP-H) of lateral cephalometry and both corresponded to severity of AHI. At the retroglossal region, there was a significant correlation with MP-H, length of the soft palate, and AHI.Conclusion. There is significant correlation of lateral cephalogram and awake flexible nasopharyngolaryngoscopy with AHI in OSA. In unison they form an excellent screening tool for snorers.

scholarly journals Case report of new-onset obstructive sleep apnea after carbon monoxide poisoning

2021 ◽  
Vol 49 (2) ◽  
pp. 030006052199222
Author(s):  
Xiaorong Yang ◽  
Min Xie ◽  
Lu Tan ◽  
Taomei Li ◽  
Xiangdong Tang
Keyword(s):  
Carbon Monoxide ◽  
Obstructive Sleep Apnea ◽  
Case Report ◽  
Sleep Apnea ◽  
Carbon Monoxide Poisoning ◽  
Apnea Hypopnea Index ◽  
Cpap Therapy ◽  
Laboratory Findings ◽  
First Case ◽  
Obstructive Sleep

Obstructive sleep apnea (OSA) is characterized by repetitive intermittent oxygen desaturation during sleep. Carbon monoxide poisoning (COP) is the second most common cause of death among non-medicinal poisonings, and oxygen therapy is the current standard of treatment for COP. We herein report a case of a 50-year-old woman diagnosed with severe OSA associated with COP. Both the OSA and COP gradually resolved by automatic continuous positive airway pressure (CPAP) therapy. New OSA symptoms appeared following the development of delayed encephalopathy after acute COP (DEACMP) 3 weeks later. Severe OSA was diagnosed 76 days after COP with an apnea–hypopnea index of 66 events/hour, and CPAP therapy was immediately administered. The patient’s DEACMP symptoms and OSA both improved with CPAP therapy (her apnea–hypopnea index decreased to 32.4 and 16.5 events/hour at 161 and 204 days after COP, respectively). To our knowledge, this is the first case report of OSA caused by COP based on the occurrence and disappearance of OSA symptoms and laboratory findings associated with the emergence and improvement of DEACMP.

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