title: [Surgical treatment of severe sleep apnea syndrome by maxillomandibular advancing or mental tranposition].
abstract: Surgery of the facial skeleton or the tongue may be envisaged in case of failure of continuous positive pressure ventilation for severe sleep apnea syndrome defined by a apnea-hyponea index greater than 30/h. We present here our results in patients treated by maxillo-mandibular advancing and mental transposition. We define the surgical indications. Between January 1993 and June 1997, 41 patients, mean age 49 years, with severe sleep apnea syndrome (mean apnea-hyponea index =58.5/h) were treated by maxillo-mandibular advancing (21 cases) or mental transposition (20 cases) depending on the cephalometric work-up including lateral teleradiography and sagittal magnetic resonance imaging of the tongue. Functional outcome was good in both groups. Objective success (postoperative apnea-hyponea index <20) was 70.5 % after bimaxillary advancing (mean apnea-hypopnea index =17), but only 25 % after mental transposition (mean apnea-hyponea index =44.5). Maxillomandibular advancing is a major procedure which can be effective in sleep apnea patients with severe craniofacial skeletal anomalies. Its applications in apneic patients with no skeletal anomaly remains a subject of debate. Conversely, there would appear to be very few indications for mental transposition.
authors.affiliation: Service d'ORL et de CCF.
authors.forename: I
authors.initials: I
authors.lastname: Wagner
authors.forename: T
authors.initials: T
authors.lastname: Coiffier
authors.forename: C
authors.initials: C
authors.lastname: Sequert
authors.forename: X
authors.initials: X
authors.lastname: Lachiver
authors.forename: B
authors.initials: B
authors.lastname: Fleury
authors.forename: F
authors.initials: F
authors.lastname: Chabolle
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D016268:Internal Fixators; D019248:Jaw Fixation Techniques / Q000295:instrumentation*; D008334:Mandible / Q000000981:diagnostic imaging / Q000601:surgery*; D008437:Maxilla / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D010614:Pharynx / Q000601:surgery; D011859:Radiography; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000601:surgery*; D014059:Tongue / Q000002:abnormalities / Q000601:surgery; D016896:Treatment Outcome
vernacular_title: Traitement chirurgical du syndrome d'apnées du sommeil sévère par avancée maxillo-mandibulaire ou par transposition génienne.