title: Efficacy of Maxillomandibular Advancement Examined with Drug-Induced Sleep Endoscopy and Computational Fluid Dynamics Airflow Modeling.
abstract: OBJECTIVE
  To use drug-induced sedation endoscopy (DISE) and computational fluid dynamics (CFD) modeling to study dynamic airway and airflow changes after maxillomandibular advancement (MMA), and how the changes correlate with surgical success based on polysomnography parameters.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  University medical center.
  
  
  METHODS
  DISE was rated with the VOTE (velum, oropharynx, tongue, epiglottis) classification, and CFD was used to model airflow velocity and negative pressure exerted on pharyngeal wall. Changes in VOTE score by site and CFD measurements were correlated with perioperative polysomnography outcomes of apnea-hypopnea index (AHI), apnea index (AI), oxygenation desaturation index (ODI), and lowest oxygen saturation.
  
  
  RESULTS
  After MMA, 20 subjects (17 males, 3 females) with a mean age of 44 ± 12 years and body mass index of 27.4 ± 4.6 kg/m(2) showed mean decreases in AHI (53.6 ± 26.6 to 9.5 ± 7.4 events/h) and ODI (38.7 ± 30.3 to 8.1 ± 9.2 events/h; P < .001). Improvement in lateral pharyngeal wall collapse during DISE based on VOTE score correlated with the most decrease in AHI (60.0 ± 25.6 to 7.5 ± 3.4 events/h) and ODI (46.7 ± 29.8 to 5.3 ± 2 events/h; P = .002). CFD modeling showed significant positive Pearson correlations between reduction of retropalatal airflow velocity and AHI (r = 0.617, P = .04) and ODI (r = 0.773, P = .005).
  
  
  CONCLUSIONS
  AHI and ODI improvement after MMA is best correlated with (1) decreased retropalatal airflow velocity modeled by CFD and (2) increased lateral pharyngeal wall stability based on VOTE scoring from DISE.
authors.affiliation: Division of Sleep Surgery, Department of Otolaryngology Head and Neck Surgery, Stanford Hospital and Clinics, Stanford, California, USA School of Medicine, Stanford University, Stanford, California, USA ycliu@stanford.edu.
authors.forename: Stanley Yung-Chuan
authors.initials: SY
authors.lastname: Liu
authors.affiliation: School of Medicine, Stanford University, Stanford, California, USA Department of Otolaryngology, Head and Neck Surgery, Cathay General Hospital, Taipei, Taiwan School of Medicine, Fu Jen Catholic University, Taipei, Taiwan.
authors.forename: Leh-Kiong
authors.initials: LK
authors.lastname: Huon
authors.affiliation: Field of Development Medicine, Health Research Course, Graduate School of Medicine and Dental Sciences, Kagoshima University, Kagoshima, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Iwasaki
authors.affiliation: School of Medicine, Stanford University, Stanford, California, USA.
authors.forename: Audrey
authors.initials: A
authors.lastname: Yoon
authors.affiliation: Division of Sleep Surgery, Department of Otolaryngology Head and Neck Surgery, Stanford Hospital and Clinics, Stanford, California, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Riley
authors.affiliation: Division of Sleep Surgery, Department of Otolaryngology Head and Neck Surgery, Stanford Hospital and Clinics, Stanford, California, USA.
authors.forename: Nelson
authors.initials: N
authors.lastname: Powell
authors.affiliation: Division of Sleep Surgery, Department of Otolaryngology Head and Neck Surgery, Stanford Hospital and Clinics, Stanford, California, USA.
authors.forename: Carlos
authors.initials: C
authors.lastname: Torre
authors.affiliation: Division of Sleep Surgery, Department of Otolaryngology Head and Neck Surgery, Stanford Hospital and Clinics, Stanford, California, USA.
authors.forename: Robson
authors.initials: R
authors.lastname: Capasso
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D004724:Endoscopy; D005260:Female; D006801:Humans; D057446:Hydrodynamics; D008297:Male; D019186:Mandibular Advancement; D008875:Middle Aged; D008962:Models, Theoretical; D017286:Polysomnography; D012189:Retrospective Studies; D012890:Sleep / Q000502:physiology*; D016896:Treatment Outcome; D055815:Young Adult
keywords: computational fluid dynamics; drug-induced sleep endoscopy; lateral pharyngeal wall collapse; maxillomandibular advancement; obstructive sleep apnea