title: Maxillomandibular advancement for persistent obstructive sleep apnea after phase I surgery in patients without maxillomandibular deficiency.
abstract: OBJECTIVE
  To assess the outcomes of maxillomandibular advancement (MMA) for the treatment of persistent obstructive sleep apnea syndrome (OSA) after phase I reconstruction in patients who do not have maxillomandibular deficiency.
  
  
  METHODS
  From January 1997 to September 1998, 25 patients previously treated with phase I reconstruction (uvulopalatoplasty, genioglossus advancement, and/or hyoid suspension) who did not have maxillary and mandibular deficiencies underwent MMA for persistent OSA. Variables examined include age, sex, body mass index (BMI), respiratory disturbance index (RDI), lowest oxygen saturation (LSAT), and cephalometric data. In addition, a minimum of 6 months after surgery, questionnaires containing a 10-cm visual analogue scale (0 = no change, 10 = drastic change) were mailed to the patients. The questionnaire subjectively assessed the patient's perception of the facial appearance after surgery, whether there was pain or discomfort of the temporomandibular joint, the overall satisfaction with the treatment outcomes, and whether the patient would recommend the operation to other patients.
  
  
  RESULTS
  Nineteen (76%) questionnaires were completed and returned by 15 men and 4 women. The mean age was 45.3 +/- 6.6 years and the mean BMI was 33.1 +/- 7.1 kg/m2. The mean RDI improved from 63.6 +/- 20.8 to 8.1 +/- 5.9 events per hour, and the mean LSAT improved from 73.3 +/- 13.2% to 88.1 +/- 4.1%. One patient was defined as an incomplete responder (RDI >20). One patient reported transient pain and discomfort of the temporomandibular joint. Although all of the patients felt that there were changes in their facial appearance after surgery, 18 of the 19 patients gave either a neutral or a favorable response to their facial esthetic results. All of these patients were satisfied with the overall outcomes and would recommend the treatment to others.
  
  
  CONCLUSIONS
  MMA is a highly effective treatment for persistent OSA after phase I surgery in patients who otherwise do not have maxillomandibular deficiency. The patient satisfaction is extremely high. Furthermore, previous concerns of unfavorable postoperative facial esthetics and temporomandibular joint dysfunction do not appear to be significant.
authors.affiliation: Stanford University Sleep Disorders and Research Center, California, USA. kaseyli@hotmail.com
authors.forename: K K
authors.initials: KK
authors.lastname: Li
authors.forename: R W
authors.initials: RW
authors.lastname: Riley
authors.forename: N B
authors.initials: NB
authors.lastname: Powell
authors.forename: C
authors.initials: C
authors.lastname: Guilleminault
mesh_terms: D015992:Body Mass Index; D002508:Cephalometry; D005260:Female; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery*; D008437:Maxilla / Q000601:surgery*; D008875:Middle Aged; D017286:Polysomnography; D012891:Sleep Apnea Syndromes / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome