title: Maxillomandibular Advancement Surgery for Patients Who Are Refractory to Continuous Positive Airway Pressure: Are There Predictors of Success?
abstract: OBJECTIVE
  This pilot study was conducted to determine the effectiveness of maxillomandibular advancement (MMA) in the treatment of patients with moderate to severe obstructive sleep apnea (OSA). The predictive value of clinical, radiographic, and treatment-related variables also was investigated in relation to the success or failure of MMA as treatment for OSA.
  
  
  METHODS
  A retrospective study design was used to assess the outcomes of MMA in patients with moderate to severe OSA (apnea hypopnea index [AHI] >15 events per hour) at the University of Michigan (Ann Arbor, MI). Data collected included clinical, radiographic, and polysomnographic findings. Primary outcomes of interest included the AHI, minimal oxygen saturation, and percentage of time spent with oxygen saturation lower than 88% as measured by polysomnography.
  
  
  RESULTS
  Twenty patients met the inclusion criteria for the study (mean age, 48.8 ± 12.3 yr). Mean body mass index decreased from 32.03 ± 5.13 kg/m2at baseline to 29.75 ± 5.23 kg/m2at follow-up (P = .001). Mean advancements were 13.5 ± 2.7 mm at point B and 16.1 ± 4.5 mm at the pogonion. A 4.5-fold increase in minimal cross-sectional area and a 2.2-fold increase in airway volume were achieved on average. Patients showed a 68.5% decrease in mean AHI from 49.4 to 15.6 events per hour (P < .001). The percentage of time with oxygen saturation lower than 88% was significantly decreased from 15.4% at baseline to 1.4% after surgery (P = .014). The overall surgical success rate was 55% (11 of 20) based on an AHI of fewer than 15 events per hour.
  
  
  CONCLUSIONS
  These preliminary results indicate that MMA surgery might be highly effective for select patients with moderate to severe OSA. Despite large increases in airway dimensions, a surgical success rate of 55% was achieved in the overall sample. Assessment of predictive variables for success and failure are discussed.
authors.affiliation: Resident, Department of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, MI. Electronic address: makovey@med.umich.edu.
authors.forename: Igor
authors.initials: I
authors.lastname: Makovey
authors.affiliation: Assistant Professor, Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, MI.
authors.forename: Anita Valanju
authors.initials: AV
authors.lastname: Shelgikar
authors.affiliation: Assistant Professor, Sleep Disorders Center, Department of Neurology and Otolaryngology-Head and Neck, University of Michigan, Ann Arbor, MI.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Stanley
authors.affiliation: Senior Statistician, Department of Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Adina
authors.initials: A
authors.lastname: Robinson
authors.affiliation: Clinical Assistant Professor, Department of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Sharon
authors.initials: S
authors.lastname: Aronovich
mesh_terms: D045422:Continuous Positive Airway Pressure; D005260:Female; D006801:Humans; D008297:Male; D019186:Mandibular Advancement / Q000379:methods; D008875:Middle Aged; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000601:surgery* / Q000628:therapy; D017211:Treatment Failure; D016896:Treatment Outcome