[Retrospective cephalometric analysis for surgically treated obstructive sleep apnea: therapeutic deductions].
OBJECTIVE
The goal of surgical treatment for severe sleep apnea syndrome is to alleviate the upper airway obstruction. The narrowing site must be precisely determined during the preoperative evaluation to ensure success. We suggest that cephalometric analysis using a lateral cephalic radiograph to evaluate bony structures combined with magnetic resonance imaging (MRI) to study soft tissues may achieve this goal. The purpose of this study was to determine the role of two different cephalometric analysis systems for determining surgical strategy and to underline factors predictive of success for different surgical procedures.


METHODS
We prospectively studied 73 sleep apnea patients. The preoperative evaluation included MRI and two different cephalometric analyses on a lateral cephalic radiograph: Tweed's and Delaire's analyses. Three surgical techniques were performed: mandibular osteotomy and geni tubercule advancement, maxillo-mandibular advancement and tongue base reduction with hypoepiglottoplasty via a cervical approach.


RESULTS
Tweed's analysis appeared to underestimate maxillo-mandibular deficiencies compared with Delaire's analysis; the later seemed to be more sensitive. MRI did not prove to be useful in predicting surgical outcome. MRI was non-contributive in our preoperative evaluation.


CONCLUSIONS
We suggest a new surgical strategy using two procedures: maxillo-mandibular advancement and tongue base reduction. Indications are based on the results of two cephalometric analyses (Tweed and Delaire) and the measurement of the oropharyngeal surface.
De Dieuleveult
T
T
Service d'ORL, chirurgie face et cou, Hôpital Foch, 40 rue Worth, 92151 Suresnes.
Wagner
I
I
Meulien
P
P
Fleury
B
B
Hausser-Hawn
C
C
Chabolle
F
F
D000328:Adult; D000368:Aged; D002508:Cephalometry; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000601:surgery*; D013514:Surgical Procedures, Operative