MAXILLOMANDIBULAR ADVANCEMENT: Primary Treatment for OSA ??? - - PowerPoint PPT Presentation

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Apr 01, 2023 214 likes •434 views

MAXILLOMANDIBULAR ADVANCEMENT: Primary Treatment for OSA ??? Sampeter L Odera DMD, MD Assistant Professor OMFS February 17 th 2018 UCSF Oral and Maxillofacial Surgery CLINICAL INDICATIONS u Significant OSA AHI >20 n +/- Hypertension,

SLIDE 1

MAXILLOMANDIBULAR ADVANCEMENT: Primary Treatment for OSA ???

Sampeter L Odera DMD, MD Assistant Professor OMFS February 17th 2018 UCSF Oral and Maxillofacial Surgery

SLIDE 2

CLINICAL INDICATIONS

u Significant OSA AHI >20

n +/- Hypertension, Stroke, arrhythmias, CHF

u Failure of CPAP due to nonadherance or

nonacceptance

u Craniofacial Anomalies u Ability to withstand surgery

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CLINICAL EVALUATION

u Clinical Evaluation to determine severity

and inspection for potential sites of

bstruction

u Temporomandibular Joint evaluation,

tooth mobility, neurosensory function, status of dentition facial esthetics

u Dental Casts and impressions

Cephalometrics

SLIDE 4

CEPHALOMETRIC ANALYSIS

SLIDE 5

Volumetric Versus 2-Dimensional Airway Analysis

SLIDE 6

u Lower mean Age u Lower preoperative AHI u Lower preoperative BMI u Larger maxillomandibular

advancements

Multivariate predictors of success Meta-analysis by Holty et al

SLIDE 7

u MMA is an effective treatment for OSA u 67 % of patients had Phase I soft

tissue treatment

u Short Term Follow-up of about 5

months

u Pre MMA AHI – 64 u Final AHI 9.5 (Mild-moderate OSA)

SLIDE 8

Meta- Analysis of 22 studies Success Tx AHI <20

r >50 % reduction AHI

Cure OSA AHI < 5

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HIERACHY OF STABILITY

More Predictable Less

Maxilla Up Mandible Forward Max Up + Mandible Forward Max Forward + Mandible Back Assymmetry Mandible Back Maxilla Down Widen Maxilla

SLIDE 12

Comparative effectiveness of MMA Boyd, JOMS 2013 MMA Long-term Stability Journal of Clinical Sleep medicine

Effectiveness and Stability of MMA

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What Role does Esthetics Play in treatment Planning Maxillomandibular advancement ?

SLIDE 15

u Pts who underwent MMA for OSAS noted

moderate changes in facial appearance

u Despite significant maxillomandibular protrusion

based on postoperative cephalometric analysis more than 90% gave either positive or neutral responses to changes in facial appearance

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Pre MMA Post MMA

SLIDE 20

Complications

u Major N=4 ~ 1% Cardiac Arrests, new

Dysrhythmia, Mandibular Fxs

u Minor

1) Temporary Paresthesia – 100 % 2) Permanent Paresthesia - 14 % 3) Relapse 4) Minor Bleeding, infections – 3%

SLIDE 21

CONCLUSIONS

u Surgical candidates should be determined

by correctly identifying sites of disproportionate UA anatomy

u Counterclockwise rotation of the

maxillomandibular complex allows for

ropharyngeal enlargement and

esthetically acceptable facial appearance

u MMA has a high therapeautic efficacy