title: Bimaxillary advancement as the initial treatment of obstructive sleep apnea: five years follow-up of the pori experience.
abstract: OBJECTIVE
  Bimaxillary advancement surgery has proven to be effective treatment of obstructive sleep apnea syndrome. According to the Stanford protocol upper airway soft tissue surgery or advancement of tongue by chin plastic surgery is first carried out and if obstructive sleep apnea persists, then bimaxillary advancement is done. This study describes the 5 year outcome of 13 obstructive sleep apnea patients in whom the Stanford protocol was omitted and bimaxillary advancement was carried out as initial surgical treatment.
  
  
  METHODS
  Patients were divided in two groups. Group A comprised patients with obstructive sleep apnea (OSAS) confirmed by polysomnography in whom ODI-4 (oxygen desaturation index) was 5 or more. Group B consisted of patients with occlusal problems needing orthognathic surgery and with OSAS symptoms but no clear disease on polysomnography, where the ODI-4 index was less than 5. Both groups were treated with bimaxillary advancement surgery (BAS) as initial therapy.
  
  
  RESULTS
  In the group A mean ODI-4 was 17.8 (SD 12) before treatment and 3.5 (SD 3.4) at 5-year follow-up (P = 0.018 in paired differences t-test). In group B the ODI-4 remained below 5. In group A mean saturation improved from 94.3% (SD 1.6) to 96.3% (SD 2), P = 0.115 and in group B from 96.3% (SD 1.2) to 97.8% (SD 1.7), P = 0.056 (in paired differences t-test). The static charge sensitive bed evaluation showed improvement in all patients except one.
  
  
  CONCLUSIONS
  Bimaxillary advancement surgery is safe and reliable as an initial surgical treatment of obstructive sleep apnea syndrome.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Institute of Dentistry, University of Oulu, Oulu Finland.
authors.forename: Antti
authors.initials: A
authors.lastname: Raunio
authors.affiliation: Department of Oral and Maxillofacial Surgery, Institute of Dentistry, University of Oulu, Oulu Finland.
authors.forename: Esa
authors.initials: E
authors.lastname: Rauhala
authors.affiliation: Department of Oral and Maxillofacial Surgery, Institute of Dentistry, University of Oulu, Oulu Finland.
authors.forename: Minna
authors.initials: M
authors.lastname: Kiviharju
authors.affiliation: Department of Oral and Maxillofacial Surgery, Institute of Dentistry, University of Oulu, Oulu Finland.
authors.forename: Ossi
authors.initials: O
authors.lastname: Lehmijoki
authors.affiliation: Department of Oral and Maxillofacial Surgery, Institute of Dentistry, University of Oulu, Oulu Finland.
authors.forename: George K B
authors.initials: GK
authors.lastname: Sándor
authors.affiliation: Department of Oral and Maxillofacial Surgery, Institute of Dentistry, University of Oulu, Oulu Finland.
authors.forename: Kyösti
authors.initials: K
authors.lastname: Oikarinen
keywords: LeFort osteotomy; mandible; maxillofacial orthognathic surgery; obstructive sleep apnea; sagittal split ramus osteotomy.; sleep-disordered breathing