G. Bettega et al., Obstructive sleep apnea syndrome - Fifty-one consecutive patients treated by maxillofacial surgery, AM J R CRIT, 162(2), 2000, pp. 641-649
The place of surgical treatment in obstructive sleep apnea syndrome (OSAS)
remains unclear. Uvulopalatopharyngoplasty (UPPP) has a response rate of 41
% overall and only 5% when retrolingual narrowing is present. Thus, in case
s with suspected hypopharyngeal collapse maxillofacial surgery has been pro
posed with improved results. The Stanford group has designed a step-by-step
surgical procedure tailored to the specific anatomical abnormalities encou
ntered in each patient. The goal is to avoid a full maxillomandibular advan
cement osteotomy (MMO), at least in a subgroup of patients, beginning with
a limited mandibular osteotomy (with or without hyoid myotomy and hyothyroi
dopexy and with or without UPPP) (phase 1 surgery). In this procedure MMO i
s performed as the second or third step (phase 2 surgery). The present stud
y reports on our prospective experience with 51 consecutive patients (64 su
rgical procedures) treated by the step-by-step maxillofacial surgery previo
usly described by the Stanford team, Only 2 of the 53 patients initially tr
eated were lost for follow-up, Surgery was considered a success if the post
operative apnea and hypopnea index (AHI) was less than 15/h with at least a
50% reduction. Forty-four patients had phase 1 surgery. The success rate w
as 22.7% (10 of 44). The mean AHI was unchanged with a trend for reduction
in the apnea index. Twenty patients had maxillomandibular advancement surge
ry (phase 2) (13 failures of phase 1, 7 patients primarily because of facio
skeletal deformities). The AHI decreased from 59 +/- 29/h to 11 +/- 9/h aft
er phase 2. Of the patients 75% (15 of 20) were considered to have had a su
ccessful outcome. In conclusion, phase 1 does not seem effective in most pa
tients with OSAS. The results of phase 2 surgery are successful in young pa
tients with severe OSAS even if the surgical technique is more aggressive.