title: Primary maxillomandibular advancement with concomitant revised uvulopalatopharyngoplasty with uvula preservation for severe obstructive sleep apnea-hypopnea syndrome.
abstract: BACKGROUND
  This study aimed to evaluate the efficacy and safety of primary maxillomandibular advancement (MMA) with concomitant adjunctive revised uvulopalatopharyngoplasty with uvula preservation (H-UPPP) in selected patients with severe obstructive sleep apnea-hypopnea syndrome (OSASH).
  
  
  METHODS
  Eleven consecutive male patients with velo-orohypopharyngeal and hypopharyngeal narrowing underwent MMA with concomitant H-UPPP for severe OSAHS. All patients underwent a physical examination, Epworth Sleepiness Scale evaluation, cephalometry, nocturnal polysomnogram, and velopharyngeal insufficiency questionnaire survey before and at 6 to 12 months after surgery.
  
  
  RESULTS
  On the basis of the success criteria, defined as an apnea-hypopnea index less than 20 and a decrease greater than 50%, the success rate was 91%. The apnea-hypopnea index decreased from 67.44 (13.30) to 9.41 (7.20) events per hour (P < 0.001) and the lowest oxygen saturation increased from 63.0% (10.70%) to 88.55% (4.59%) (P < 0.001) after surgery. All patients showed a significant decrease in mandibular plane to hyoid bone and increase in PAS after surgery. One patient reported regurgitation of liquids when drinking hastily after surgery. Two patients reported regurgitation as occasional occurrences. Half a year later, 2 patients reported complete resolution of the symptoms. One patient still complained of rare regurgitation of liquids when drinking quickly. Five patients had paresthesia of the lower lip; in 4 patients, the paresthesia had resolved by 12 months after surgery. One patient still complained of paresthesia of the lower lip after 2 years of follow-up. No major complication (eg, upper airway obstruction) occurred.
  
  
  CONCLUSIONS
  Primary MMA with concomitant adjunctive H-UPPP is effective in selected patients with severe OSAHS without major complications.
authors.affiliation: Department of Otorhinolaryngology, Affiliated Sixth People's Hospital of Shanghai Jiaotong University, Shanghai, China.
authors.forename: Su Ru
authors.initials: SR
authors.lastname: Liu
authors.forename: Hong Liang
authors.initials: HL
authors.lastname: Yi
authors.forename: Shan Kai
authors.initials: SK
authors.lastname: Yin
authors.forename: Jian
authors.initials: J
authors.lastname: Guan
authors.forename: Bin
authors.initials: B
authors.lastname: Chen
authors.forename: Li Li
authors.initials: LL
authors.lastname: Meng
authors.forename: Jian Yin
authors.initials: JY
authors.lastname: Zou
authors.forename: Wei Tian
authors.initials: WT
authors.lastname: Zhang
mesh_terms: D000328:Adult; D002508:Cephalometry; D006801:Humans; D008297:Male; D019186:Mandibular Advancement; D008437:Maxilla / Q000601:surgery; D063166:Maxillary Osteotomy; D056948:Orthognathic Surgical Procedures / Q000379:methods*; D010160:Palate, Soft / Q000601:surgery; D010614:Pharynx / Q000601:surgery; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D014609:Uvula / Q000601:surgery