title: Orthognathic surgery in the management of obstructive sleep apnoea: experience from maxillofacial surgery unit in the United Kingdom.
abstract: In the United Kingdom, maxillofacial techniques are underused in the treatment of obstructive sleep apnoea (OSA). We retrospectively analysed the details and relevant clinical data of consecutive patients who had operations for OSA at the maxillofacial unit in Leicester between 2002 and 2012. They had been referred from the local sleep clinic after investigation and diagnosis, and in all cases treatment with continuous positive airway pressure (CPAP) had failed. We compared preoperative and postoperative apnoea/hypopnoea indices (AHI), scores for the Epworth sleepiness scale (ESS), and lowest oxygen saturation to measure surgical success (AHI of less than 15 and a 50% reduction in the number of apnoeas or hypopnoea/hour) and surgical cure (AHI of less than 5). We identified 51 patients (mean age 44 years, range 21-60) with a mean (SD) body mass index (BMI) of 29 (3.4). Most patients had bimaxillary advancement with genioplasty (n=42). Differences in mean (SD) preoperative and postoperative values were significant for all 3 outcome measures (AHI: 42 (17) to 8 (7) p<0.001; ESS: 14 (4) to 5 (4) p<0.001; lowest oxygen saturation: 76% (11%) to 83% (7%); p=0.006). On the postoperative sleep study 85% of patients met the criteria for surgical success. Our experience has confirmed that bimaxillary advancement results in a high rate of success in patients with OSA. The operation has a role in the management of selected patients in the UK who do not adhere to CPAP.
authors.affiliation: Department of Maxillofacial Surgery, Leicester Royal Infirmary, Infirmary Square, Leicester, East Midlands LE1 5WW, UK. Electronic address: drshafiqislam@hotmail.co.uk.
authors.forename: Shofiq
authors.initials: S
authors.lastname: Islam
authors.affiliation: Department of Maxillofacial Surgery, Leicester Royal Infirmary, Infirmary Square, Leicester, East Midlands LE1 5WW, UK.
authors.forename: Nosa
authors.initials: N
authors.lastname: Uwadiae
authors.affiliation: Department of Maxillofacial Surgery, Leicester Royal Infirmary, Infirmary Square, Leicester, East Midlands LE1 5WW, UK.
authors.forename: Ian W
authors.initials: IW
authors.lastname: Ormiston
mesh_terms: D000328:Adult; D015992:Body Mass Index; D045422:Continuous Positive Airway Pressure / Q000706:statistics & numerical data; D004739:England; D005260:Female; D005500:Follow-Up Studies; D063172:Genioplasty / Q000706:statistics & numerical data; D006801:Humans; D006987:Hypesthesia / Q000209:etiology; D008297:Male; D019186:Mandibular Advancement / Q000706:statistics & numerical data; D008437:Maxilla / Q000601:surgery; D008875:Middle Aged; D056948:Orthognathic Surgical Procedures / Q000706:statistics & numerical data*; D019340:Osteotomy, Le Fort / Q000706:statistics & numerical data; D059229:Osteotomy, Sagittal Split Ramus / Q000706:statistics & numerical data; D010100:Oxygen / Q000097:blood; D010292:Paresthesia / Q000209:etiology; D011183:Postoperative Complications; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000145:classification / Q000601:surgery*; D012894:Sleep Stages / Q000502:physiology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D010100:Oxygen
keywords: Cure rate; Maxillofacial surgery; Maxillomandibular advancement; Obstructive sleep apnoea; Orthognathic surgery; Success rate; UK