title: Primary and secondary telegnathic maxillomandibular advancement, with or without adjunctive procedures, for obstructive sleep apnea in adults: a literature review and treatment recommendations.
abstract: OBJECTIVE
  To further define the role, surgical principles, and therapeutic efficacy of primary and secondary maxillomandibular advancement (MMA), with and without intrapharyngeal or extrapharyngeal adjunctive procedures, for obstructive sleep apnea in adults.
  
  
  METHODS
  A review of the literature, using mean percent reduction in apnea hypopnea index as the primary outcome measure of therapeutic efficacy for standardized comparison. Other occasionally reported MMA outcome parameters were sleep staging variables, lowest oxyhemoglobin saturation levels, Epworth scores, blood pressure changes, lateral cephalometric data, and complications.
  
  
  RESULTS
  Mean percent reduction in apnea hypopnea index was 92.1% for primary MMA with extrapharyngeal procedures, 88.4% for primary MMA, 86.6% for secondary MMA, 79.4% for primary MMA with intrapharyngeal procedures, 53.0% for non-MMA multilevel surgery, 31.3% for uvulopalatopharyngoplasty, and 89.8% for nasal continuous positive airway pressure. Treatment recommendations for telegnathic MMA included surgical goals and guidelines, indications and staging protocols, surgical principles and techniques, and postoperative airway management.
  
  
  CONCLUSIONS
  Primary and secondary MMA are highly therapeutic, and extrapharyngeal are more therapeutic than intrapharyngeal procedures when performed concomitantly with primary MMA. However, long-term success of obstructive sleep apnea treatment should be measured by a yet undefined comprehensive algorithm of standardized multiple weighted outcome parameters.
authors.affiliation: Private Practice in Oral and Maxillofacial Surgery, Marietta, GA, USA. drprinsell@mindspring.com
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Prinsell
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D006801:Humans; D008334:Mandible / Q000601:surgery*; D008437:Maxilla / Q000601:surgery*; D056948:Orthognathic Surgical Procedures / Q000379:methods*; D010614:Pharynx / Q000473:pathology / Q000601:surgery; D017410:Practice Guidelines as Topic; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D016896:Treatment Outcome