title: Three-dimensional computed tomographic airway analysis of patients with obstructive sleep apnea treated by maxillomandibular advancement.
abstract: OBJECTIVE
  To evaluate changes in airway size and shape in patients with obstructive sleep apnea (OSA) after maxillomandibular advancement (MMA) and genial tubercle advancement (GTA).
  
  
  METHODS
  This was a retrospective cohort study, enrolling a sample of adults with polysomnography-confirmed OSA who underwent MMA + GTA. All subjects who had preoperative and postoperative 3-dimensional computed tomography (CT) scans to evaluate changes in airway size and shape after MMA + GTA were included. Preoperative and postoperative sleep- and breathing-related symptoms were recorded. Descriptive and bivariate statistics were computed. For all analyses, P < .05 was considered statistically significant.
  
  
  RESULTS
  During the study period, 13 patients underwent MMA + GTA, of whom 11 (84.6%) met the inclusion criteria. There were 9 men and 2 women with a mean age of 39 years. The mean body mass index was 26.3; mean respiratory disturbance index (RDI), 48.8; and mean lowest oxygen saturation, 80.5%. After MMA + GTA, there were significant increases in lateral and anteroposterior airway diameters (P < .01), volume (P = .02), surface area (P < .01), and cross-sectional areas at multiple sites (P < .04). Airway length decreased (P < .01) and airway shape (P = .04) became more uniform. The mean change in RDI was -60%.
  
  
  CONCLUSIONS
  Results of this preliminary study indicate that MMA + GTA appears to produce significant changes in airway size and shape that correlate with a decrease in RDI.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA 02114, USA.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Abramson
authors.forename: Srinivas M
authors.initials: SM
authors.lastname: Susarla
authors.forename: Matthew
authors.initials: M
authors.lastname: Lawler
authors.forename: Carl
authors.initials: C
authors.lastname: Bouchard
authors.forename: Maria
authors.initials: M
authors.lastname: Troulis
authors.forename: Leonard B
authors.initials: LB
authors.lastname: Kaban
mesh_terms: D000328:Adult; D002680:Chin / Q000601:surgery; D015331:Cohort Studies; D054893:Cone-Beam Computed Tomography; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D019186:Mandibular Advancement; D008437:Maxilla / Q000601:surgery; D009765:Obesity / Q000150:complications; D009971:Orthodontics, Corrective; D056948:Orthognathic Surgical Procedures / Q000379:methods*; D019340:Osteotomy, Le Fort; D010614:Pharynx / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods