title: Improved apnea-hypopnea index and lowest oxygen saturation after maxillomandibular advancement with or without counterclockwise rotation in patients with obstructive sleep apnea: a meta-analysis.
abstract: OBJECTIVE
  This study investigated whether patients with obstructive sleep apnea (OSA) who undergo maxillomandibular advancement (MMA) with counterclockwise (CCW) rotation compared with those who undergo MMA without CCW rotation have better outcomes.
  
  
  METHODS
  This was a systematic review with meta-analysis. The Medline and Cochrane databases were searched for randomized controlled trials using Medical Subject Headings. The predictor variable was operative technique, namely MMA with or without CCW rotation of the maxillofacial complex. The key outcome variables were changes in pre- and postsurgical values of pharyngeal volume measured on computed tomogram or cone-beam computed tomogram and changes in Apnea-Hypopnea Index (AHI) and lowest oxygen saturation (LSAT) values after surgery. Data were subjected to a meta-analysis based on odds ratios (OR) with 95% confidence intervals (CIs) and P values lower than .05 by χ(2) test were considered significant.
  
  
  RESULTS
  Twenty-one randomized controlled trials were identified and 4 were assessed for the variables of interest. Postoperative AHI and LSAT measurements showed vast improvement. The sample was not large enough to make a correlation between pharyngeal volume changes and surgical method used. Postoperative parameters included an AHI lower than 5 (OR = 14.9; 95% CI, 2.7-83.5; P = .002), an AHI lower than 20 (OR = 114.8; 95% CI, 23.5-561.1; P <.00001), pooled results of a 50% decrease in the AHI (OR = 6.1; 95% CI, 2.2-17.0; P = .0006), and an increase greater than 90% in LSAT measurements during sleep (OR = 6.0; 95% CI, 1.8-19.9; P = .003). The funnel plot showed no evidence of publication bias.
  
  
  CONCLUSIONS
  CCW-MMA or MMA in patients with OSA results in a statistically meaningful decrease in postoperative AHI and a statistically meaningful increase in postoperative LSAT.
authors.affiliation: Consultant, Department of Otorhinolaryngology and Maxillofacial Surgery, Køge University Hospital, Køge, Denmark. Electronic address: thorkildk@hotmail.com.
authors.forename: Thorkild B
authors.initials: TB
authors.lastname: Knudsen
authors.affiliation: PhD Student, Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark.
authors.forename: Anne S
authors.initials: AS
authors.lastname: Laulund
authors.affiliation: Consultant, Department of Oral and Maxillofacial Surgery, Hospital of South West Denmark, Esbjerg, Denmark.
authors.forename: Janne
authors.initials: J
authors.lastname: Ingerslev
authors.affiliation: Professor, Department of Otorhinolaryngology and Maxillofacial Surgery, Køge University Hospital, Køge, Denmark.
authors.forename: Preben
authors.initials: P
authors.lastname: Homøe
authors.affiliation: Professor and Consultant, Department of Oral and Maxillofacial Surgery, Hospital of South West Denmark, Esbjerg, Denmark.
authors.forename: Else M
authors.initials: EM
authors.lastname: Pinholt
mesh_terms: D006801:Humans; D019186:Mandibular Advancement / Q000379:methods*; D008437:Maxilla / Q000601:surgery*; D056948:Orthognathic Surgical Procedures / Q000379:methods*; D010100:Oxygen / Q000097:blood*; D010614:Pharynx / Q000473:pathology; D012399:Rotation; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D010100:Oxygen