Surgical treatment of obstructive sleep apnea by maxillomandibular advancement
Abstract
In recent years obstructive sleep apnea syndrome has gained increasing interest. Treatment of choice is nasal continuous positive airway pressure ventilation during sleep for upper airway patency, which does not cure sleep apnea and has to be applied throughout a patient's lifetime. In respect to various underlying pathomechanisms, in certain cases with craniofacial disorders, causal therapy by craniofacial osteotomies seems possible. A series of 21 consecutive patients with maxillary and mandibular deficiency were treated primarily with a 10-mm maxillomandibular advancement by retromolar sagittal split osteotomy and Le Fort-I osteotomy, respectively. Obstructive sleep apnea syndrome was considerably improved in all patients. In 20 of 21 patients, the postoperative respiratory disturbance index (RDI) was reduced clearly to under 10, oxygen saturation rose and sleep quality improved. This was achieved by a maxillomandibular advancement of 10 mm without secondary refinements. In one patient the RDI could only be reduced to 20, probably due to insufficient maxillary advancement; oxygen desaturations still existed despite secondary corrections. These results indicate that successful surgical treatment is possible in a high percentage of selected patients with certain craniofacial characteristics. In addition to cardiorespiratory polysomnography there should be routine cephalometric evaluation of all patients. Maxillomandibular advancement should be offered as an alternative therapy to all patients with maxillary and/or mandibular deficiency or dolichofacial type in combination with narrow posterior airway space.
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Several complications have been reported after MMA, including cardiac arrest without sequellae and dysrythmia, local infection, perforation of the palate, a maxillary pseudarthrosis, malocclusion, and dysgnathia due to mandibular deficiencies.
“Several complications have been reported, including cardiac arrest without sequellae and dysrythmia 310, local infection, perforation of the palate, a maxillary pseudarthrosis, malocclusion, and dysgnathia due to mandibular deficiencies 305–309, 311–314.”
From Non-CPAP therapies in obstructive sleep apnoea (2011) · cites this paper as [306]
In Surgical principles (page unavailable), the two patients’ mandibular deficiencies and dysgnathias are described as existing before surgery; the paper says the bite was corrected during advancement, not that dysgnathia arose afterward. It does not report the other listed complications, so the claim that this source reports dysgnathia as a postoperative complication is contrary to its account. (LLM, conf=0.78)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredThe success rate of MMA varied between 67% and 100%.
“The success rate varied between 67% and 100% 305–307.”
From Non-CPAP therapies in obstructive sleep apnoea (2011) · cites this paper as [306]
The Results and Conclusions (page not specified in our copy) report a postoperative RDI below 10 in 20 of 21 patients, an approximately 95% success rate by that measure. This falls within the cited range, but this paper does not establish its 67% or 100% endpoints. (LLM, conf=0.86)
Experimental — accuracy not yet measuredAll series, including 298 patients, demonstrated an improvement of postoperative sleep macrostructure after MMA.
“All series, including 298 patients, demonstrated an improvement of postoperative sleep macrostructure (table e31) 306–308.”
From Non-CPAP therapies in obstructive sleep apnoea (2011) · cites this paper as [306]
The Results and Table 3 report improved postoperative sleep quality in this 21-patient MMA series, including an increase in slow-wave sleep from 8.4% to 15.1% of total sleep time. This paper does not establish the claim about all series comprising 298 patients. (LLM, conf=0.87)
Experimental — accuracy not yet measuredThe level of evidence for MMA is based on 12 series published between 1989 and 2006.
“The level of evidence is based on 12 series published between 1989 and 2006 (table e31) 305–316.”
From Non-CPAP therapies in obstructive sleep apnoea (2011) · cites this paper as [306]
A quarter of the remaining respiratory abnormalities after MMA were central events.
“A quarter of the remaining respiratory abnormalities were central events 306.”
From Non-CPAP therapies in obstructive sleep apnoea (2011) · cites this paper as [306]
The Sleep studies section says breathing disorders were classified as obstructive, mixed, or central, and the Results report postoperative respiratory disturbances. Neither section gives the proportion of remaining events that were central; searches for central events and a 25% postoperative share found no such figure in our copy. (LLM, conf=0.72)
Experimental — accuracy not yet measured
The discrepancy in MMA success rates can be explained by different polysomnographic techniques.
“The discrepancy can be explained by different polysomnographic techniques 305–307.”
From Non-CPAP therapies in obstructive sleep apnoea (2011) · cites this paper as [306]
The Sleep studies section describes this study’s polysomnographic methods, and the Results report its postoperative outcomes. Neither passage compares MMA success rates across studies or says that differences in polysomnographic techniques explain a discrepancy. Searches for that explanation and for differences in scoring criteria found no supporting passage in our copy. (LLM, conf=0.75)
Experimental — accuracy not yet measured
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- Authors
- Hochban, W., Brandenburg, U., & Peter, J. H.
- Affiliations
- Philipps University of Marburg (DE)
- ORCID
- Brandenburg, Ulrich
- Venue
- Sleep
- Publisher
- Oxford University Press (OUP)
- Published
- 1994-10
- Volume
- 17
- Issue
- 7
- Pages
- 624-629
- ISSN
- 0161-8105 (ISSN-L)
- 1550-9109
- OpenAlex
- W2409264478
- Cited by
- 164
- References
- 6
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 1 · 2023: 4 · 2022: 1 · 2021: 1 · 2020: 2 · 2019: 6 · 2018: 2 · 2017: 7 · 2016: 3 · 2015: 6 · 2014: 8 · 2013: 5 · 2012: 18
- FWCI
- 3.62
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- SLEEP (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Health Sciences › Dentistry › Orthodontics › Orthodontics and Dentofacial Orthopedics
- Health Sciences › Health Professions › Complementary and Manual Therapy › Temporomandibular Joint Disorders
- Keywords
- obstructive sleep apnea, maxillomandibular advancement, Le Fort I osteotomy, maxillary hypoplasia, mandibular deficiency, respiratory disturbance index, oxygen desaturation, cephalometric analysis, CPAP alternative
- MeSH terms
- Adult, Cephalometry, Female, Humans, Male, Mandible, Maxilla, Middle Aged, Osteotomy, Sleep Apnea Syndromes, Polysomnography
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