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Surgical Planning for Management of Obstructive Sleep Apnea: A Systematic Review of the Literature.
Isaac Mordukhovich, Anthony DeLeonibus, MD; Ian Zelko, DO; Maria A. DeLeonibus, DMD; Abir Kalandar, MBBCh; Bahar Bassiri Gharb, MD PhD; Francis Papay, MD; Antonio Rampazzo, MD PhD
Case Western Reserve University School of Medicine
2025-01-16
Presenter: Isaac Mordukhovich
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. The program director is responsible for making a statement within the confines of the box below specific to how much of the work on this project represents the original work of the resident. All authors/submitters of each abstract should discuss this with their respective program director for accurate submission of information as well as the program director's approval for inclusion of his/her electronic signature.
Director Name: Bahar Bassiri Gharb, MD, PhD
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Objective: This study is a systematic review of surgical planning used in maxillomandibular advancement (MMA) treatment of obstructive sleep apnea (OSA).
Methods: PubMed, Medline, Cochrane, and Web of Science databases were searched for peer-reviewed, English-language papers from January 1989 to November 2022 which discussed treatment of OSA with MMA. Weighted, pooled standard deviations were calculated for Welch's t-tests in evaluation of craniofacial parameters.
Results: Forty-five articles were accessed with information on the treatment of 1175 patients (reported 186 female and 771 male). Average age was 43.8±10.4 years and at least 224 patients (19.1%) previously received uvulopalatopharyngoplastyl, with nasal reconstruction (>10.3%) the next most common prior surgery. Mandible-first MMA was performed in 30.7% of patients while the remainder were maxilla-first. Significant differences were found between changes in craniofacial features with counterclockwise rotational versus linear MMA. Model surgery and virtual surgical planning were used by 9 and 7 studies, respectively. Maxillary advancement was significantly greater in linear (8.37±1.98 mm) than in rotational (4.54±2.26 mm) procedures (p<0.001). Mandibular advancement was also greater in linear MMA (10.45±2.31 mm vs. 9.81±3.04 mm; p=0.023). Posterior airway space (p=0.540), sella-nasion-B point angle (p=0.475), and sella-nasion-A point angle (p=0.053) did not differ between MMA types. Rotational MMA was first used in the extracted records in 2013, but 48% of later studies included at least some planned rotation.
Conclusion: Rotational MMA has increasingly replaced linear MMA for OSA, significantly affecting the anatomical changes observed. However, surgical planning varies widely between centers and airway volume measures are not widely considered.
