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A Journal on Diseases of the Respiratory System
Official Journal of the Italian Society of Thoracic Endoscopy
Indexed/Abstracted in: EMBASE, Scopus
Minerva Pneumologica 2008 December;47(4):203-12
Maxillomandibular advancement surgery for obstructive sleep apnea treatment
Cao M., Li K. K., Guilleminault C.
Stanford Sleep Disorders Center Stanford University, Stanford, CA, USA
Although nasal continuous positive airway pressure therapy is considered the first-line treatment for obstructive sleep apnea, surgery has been shown to be a valid option for patients who are intolerant to positive pressure therapy. In the last 20 years, maxillomandibular advancement surgery has been widely accepted as the most effective surgical therapy for the treatment of obstructive sleep apnea syndrome. Maxillomandibular advancement has been shown to enlarge the pharyngeal and hypopharyngeal airway by physically expanding the facial skeletal framework. In addition, the forward movement of the maxillomandibular complex increases tissue tension, therefore decreasing the collapsibility of the velopharyngeal and suprahyoid musculature as well as improving lateral pharyngeal wall collapse, all of which have been demonstrated as significant components contributing to upper airway obstruction in obstructive sleep apnea. Since maxillomandibular deficiencies based on cephalometric measurements have been shown to be a significant finding in patients with obstructive sleep apnea, maxillomandibular advancement surgery was first described and advocated in patients with significant jaw deficiencies. However, some have advocated this surgical approach for the treatment of obstructive sleep apnea in patients with relatively minimal maxillomandibular deficiencies as well. The outcome of maxillomandibular advancement surgery has been extensively reported, with success ranging between 57% and 100%. The long term success rate approaches 90%. Published data demonstrating improvement in quality of life after surgery are also available.