[Different maxillomandibular advancement methods for the treatment of severe obstructive sleep apneahypopnea syndrome].

OBJECTIVE: To review the outcomes of three different methods of maxillomandibular advancement for the treatment of severe obstructive sleep apnea-hypopnea syndrome (OSAHS). METHODS: Twenty-four patients with severe OSAHS from January 2011 to January 2014 treated by three different methods of maxillomandibular advancement (MMA) and genioplasty, maxillomandibular advancement without rotation plus genioplasty, maxillomandibular advancement with counterclockwise rotation plus advancement genioplasty, maxillomandibular advancement with first premolars extraction and subapical osteotomy setback under general anesthesia were included in the study. Comparison of per-operative and post-operative cephalometric analysis, polysomnography (PSG), apnea and hypopea index (AHI), body mass index (BMI), average blood oxygen saturation (AOS), lowest oxygen saturation (LSaO2) and posterior airway space (PAS) data were performed. The operative time and post-surgical orthodontic treatment data were collected and analyzed. RESULTS: According to Stanford criteria, the success rate of 100% was achieved with all the three methods. The difference between per-operative and post-operative AHI, AOS, SNPg and PAS were statistically significant (P<0.0001) for all the three methods. Significant difference was found between per-operative and post-operative SNA (81.51 degrees +/-3.36 degrees vs 88.17 degrees +/-4.51 degrees , P<0.0001), (82.25 degrees +/-2.71 degrees vs 86.54 degrees +/-3.65 degrees , P=0.0002) and SNB (72.37 degrees +/-3.99 degrees vs 80.59 degrees +/-3.40 degrees , P<0.0001), (73.65 degrees +/-3.80 degrees vs 81.37 degrees +/-2.96 degrees , P<0.0001) among MMA without rotation plus genioplasty and MMA with counterclockwise rotation and advancement genioplasty respectively. However, no significant difference was found between the pre-operative and post-operative SNA (82.18 degrees +/-4.27 degrees vs 84.19 degrees +/-2.70 degrees , P=0.2015) and SNB (73.28 degrees +/-3.04 degrees vs 75.35 degrees +/-2.56 degrees , P=0.2640) among MMA with first premolars extraction and subapical osteotomy setback. The average duration of postoperative orthodontics treatment was 8.3 months. CONCLUSIONS: MMA and advancement genioplasty is an effective surgical management for severe OSAHS. Cephalometric analysis and computer aided design are needed for personalized surgical methods. MMA without rotation and advancement genioplasty method leads to the protrusive skeletal deformity. MMA with counterclockwise rotation and advancement genioplasty method is effective in curing severe OSAHS with little effect on facial profile. MMA with first premolars extraction and subapical osteotomy requires longer operative time and longer postoperative orthodontic treatment.