LONG-TERM FOLLOW-UP AFTER SURGICAL-TREATMENT OF OBSTRUCTIVE SLEEP-APNEA BY MAXILLOMANDIBULAR ADVANCEMENT

Obstructive sleep apnoea (OSA) is a common disorder with potentially s erious consequences. If maxillary and mandibular deficiency, often in combination with a narrow posterior airway space is present, therapy o f OSA by maxillomandibular osteotomy is possible. However, long-term f ollow-up of patients undergoing these procedures is lacking. We presen t the results of 15 OSA patients (1 female and 14 males), who underwen t maxillomandibular advancement surgery with a follow-up of at least 2 yrs. Polysomnography was performed before surgery, after 6-12 weeks, and 1 and 2 yrs postoperatively. Mean apnoea/hypopnoea index (AHI) dec reased from 51.4 events . h(-1) before therapy to 5.0 events . h(-1) 6 weeks postoperatively, and was 8.5 events . h(-1) after 2 yrs. Oxygen saturation significantly increased following surgery. After 2 yrs, th e AHI was <10 events . h(-1) in 12 out of 15 subjects. No significant changes were found comparing the 6-12 weeks versus the 2 year follow-u p data. The significant increase in stage 3/4 non-rapid eye movement ( NREM) sleep and decrease in stage 1 NREM sleep, indicative of the rest oration of normal physiological sleep structure, persisted in 14 of th e 15 subjects 2 yrs postoperatively. Three patients, however, did not show satisfactory improvement 2 yrs postoperatively; two showed obstru ctive and one central respiratory events. This study demonstrates that maxillomandibular advancement is successful in a high percentage of p atients carefully selected by cephalometric and polysomnographic inves tigation. Postoperative success has proved to be stable over a period of 2 yrs. Further preoperative evaluation seems necessary in patients with pre dominantly mixed or central apnoeas. (C)ERS Journals Ltd 1997 .