title: Virtual surgical planning improves surgical outcome measures in obstructive sleep apnea surgery.
abstract: OBJECTIVE
  Determine the feasibility and accuracy of using virtual surgical planning (VSP) to direct the surgical and polysomnography (PSG) outcomes of patients with obstructive sleep apnea (OSA).
  
  
  METHODS
  Prospective case series.
  
  
  METHODS
  Skeletal and soft tissue dimensions were measured from computed tomography (CT) to include posterior airway space (PAS) diameters at the occlusal (PAS-O) and mandibular (PAS-M) plane, position of the maxilla, and tooth-to-lip distance. All patients underwent an in-lab attended PSG whereby apnea-hypopnea index (AHI), respiratory disturbance index (RDI), and lowest oxyhemoglobin saturation percent (LSAT) were measured preoperatively and at least 9 months postoperatively.
  
  
  RESULTS
  Four patients with OSA demonstrated a mean AHI and RDI of 60.1 and 69.5 events per hour, respectively. The mean preoperative LSAT was 76%. Mean CT-based measures for PAS-O and PAS-M were 3.08 mm and 9.03 mm, respectively. VSP was used to direct the amount of advancement and impaction in maxillomandibular advancement (MMA) surgery. The mean PAS-O and PAS-M postoperative measures significantly increased to 8.15 and 14 mm (P < .004), whereas the mean tooth-to-lip relationship stayed the same, 3.17 to 3.18, P = .98. The AHI and RDI significantly improved to 2.83 and 4.5 events per hour, respectively, P = .03, whereas the LSAT improved from 76% to 87%.
  
  
  CONCLUSIONS
  VSP for MMA in OSA patients is feasible and safe while offering improvements in the predictability of airway change and tooth-to-lip measures.
authors.affiliation: Division of Sleep Surgery and Facial Plastic Surgery, Department of Otolaryngology, San Antonio Military Medical Center, Fort Sam Houston, Texas, U.S.A.
authors.forename: Jose E
authors.initials: JE
authors.lastname: Barrera
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D019186:Mandibular Advancement; D008437:Maxilla / Q000601:surgery; D008875:Middle Aged; D056948:Orthognathic Surgical Procedures / Q000379:methods*; D017063:Outcome Assessment, Health Care; D010347:Patient Care Planning; D017286:Polysomnography; D011446:Prospective Studies; D020181:Sleep Apnea, Obstructive / Q000000981:diagnostic imaging* / Q000601:surgery*; D025321:Surgery, Computer-Assisted; D014057:Tomography, X-Ray Computed; D014584:User-Computer Interface
keywords: Obstructive sleep apnea; radiology; virtual surgical planning