title: Oral appliances and maxillomandibular advancement surgery: an alternative treatment protocol for the obstructive sleep apnea-hypopnea syndrome.
abstract: OBJECTIVE
  The present study comprises a retrospective evaluation of the potential application of mandibular repositioning appliance (MRA) therapy preceding maxillomandibular advancement (MMA) surgery in the treatment of the Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS). Our initial experiences with a new surgical protocol, in which MRA therapy serves as a predictor for success of MMA surgery, are reported.
  
  
  METHODS
  Forty-three consecutive patients with OSAHS treated with MRA therapy were considered for inclusion (mean+/-SD; Apnea-Hypopnea Index [AHI]=27+/-20; age=53+/-9 years). All patients displaying a substantial improvement in their AHI with MRA therapy (ie,>50% reduction) who preferred surgical rather than "prosthetic" advancement of the mandible were offered MMA surgery. Accordingly, 4 out of 43 patients were treated with MMA surgery. The AHI was used as the primary outcome measure, with MMA surgery being considered successful in case of a postoperative AHI <5.
  
  
  RESULTS
  All 4 patients included displayed substantial improvement in their AHI following MRA therapy. Moreover, in 3 patients MRA therapy resulted in a post-treatment AHI <or=5. With respect to the primary outcome measure, successful OSAHS management was attained in all 4 patients following MMA surgery.
  
  
  CONCLUSIONS
  Results from the 4 patients included in the present study suggest that MRA therapy might be a good predictor for the success of MMA surgery in OSAHS management. Although confirmation in a larger study sample is indicated, we conclude that patients with a substantial reduction in baseline AHI with MRA therapy appear to be candidates for MMA surgery.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. a.hoekema@kchir.umcg.nl
authors.forename: Aarnoud
authors.initials: A
authors.lastname: Hoekema
authors.forename: Jan
authors.initials: J
authors.lastname: de Lange
authors.forename: Boudewijn
authors.initials: B
authors.lastname: Stegenga
authors.forename: Lambert G M
authors.initials: LG
authors.lastname: de Bont
mesh_terms: D000328:Adult; D002985:Clinical Protocols; D006801:Humans; D019248:Jaw Fixation Techniques / Q000295:instrumentation; D019186:Mandibular Advancement / Q000295:instrumentation* / Q000379:methods*; D008437:Maxilla / Q000601:surgery*; D008875:Middle Aged; D009967:Orthodontic Appliances; D011300:Preoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome