title: Counterclockwise maxillomandibular advancement: a choice for Chinese patients with severe obstructive sleep apnea.
abstract: OBJECTIVE
  Maxillomandibular advancement (MMA) is an effective alternative for treating severe obstructive sleep apnea (OSA). However, the promotion of MMA in China is limited by many Chinese patients having a convex facial profile. To achieve maximal upper airway enlargement without an esthetic disaster, we added counterclockwise rotation of the maxillomandibular complex (MMC) in the routine MMA. In this paper, we have evaluated the objective and subjective outcomes of this technology.
  
  
  METHODS
  In total, 33 severe OSA patients who accepted counterclockwise maxillomandibular advancement (CMMA) were investigated in this study. Genioplasty, uvulopalatopharyngoplasty (UPPP), and turbinate reduction were also performed on selected patients. Polysomnography (PSG) and Epworth sleepiness scale (ESS) were chosen to evaluate the effectiveness of this technology in treating OSA. Patients' facial appearances were evaluated by cephalometric analysis and 5-point Likert scales.
  
  
  RESULTS
  After CMMA, the apnea-hypopnea index (AHI) decreased from 59.3 ± 14.6 to 10.2 ± 6.7 (P < 0.001), minimum SpO2 (pulse oxygen saturation, %) increased from 74.0 ± 11.7 to 88.8 ± 4.4 (P < 0.001), and ESS decreased from 12.5 ± 2.3 to 7.3 ± 2.1. It is encouraging that soft-tissue cephalometric measurements such as facial convexity angle, nasolabial angle, and labiomental fold were not worsening after surgery. The Likert scales revealed that 28 patients (85%) were satisfied or very satisfied with their facial changes. In addition, no patient complained about dental function after surgery.
  
  
  CONCLUSIONS
  These findings indicate that CMMA is an effective way to achieve a balance between airway enlargement and facial appearance for Chinese patients with severe OSA.
authors.affiliation: Department of Oral and Craniomaxillofacial Sciences, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.
authors.forename: Silong
authors.initials: S
authors.lastname: Wei
authors.affiliation: Department of Oral and Craniomaxillofacial Sciences, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Stomatology, Shanghai Jiao Tong University affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
authors.forename: Xiaojing
authors.initials: X
authors.lastname: Guo
authors.affiliation: Department of Oral and Craniomaxillofacial Sciences, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.
authors.forename: Wenwen
authors.initials: W
authors.lastname: Yu
authors.affiliation: Department of Oral and Craniomaxillofacial Sciences, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.
authors.forename: Meng
authors.initials: M
authors.lastname: Wang
authors.affiliation: Department of Oral and Craniomaxillofacial Sciences, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.
authors.forename: Kan
authors.initials: K
authors.lastname: Yao
authors.affiliation: Department of Oral and Craniomaxillofacial Sciences, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.
authors.forename: Hongxia
authors.initials: H
authors.lastname: Sun
authors.affiliation: Department of Oral and Craniomaxillofacial Sciences, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China. zhanghuakcb@126.com.
authors.forename: Hua
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Oral and Craniomaxillofacial Sciences, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China. lukeluxf@163.com.
authors.forename: Xiaofeng
authors.initials: X
authors.lastname: Lu
mesh_terms: D000293:Adolescent; D000328:Adult; D044466:Asian People; D002681:China; D005260:Female; D006801:Humans; D008297:Male; D008334:Mandible; D019186:Mandibular Advancement / Q000379:methods*; D008437:Maxilla; D008875:Middle Aged; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology* / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Counterclockwise rotation; Esthetics; Maxillomandibular advancement; Obstructive sleep apnea