Angelica Walker, Mohamed F Kassir, Vineeth Sama, Shaun A Nguyen, Mohamed Abdelwahab
{"title":"Maxillomandibular Advancement Safety and Effectiveness in Obstructive Sleep Apnea: Systematic Review and Meta-Analysis.","authors":"Angelica Walker, Mohamed F Kassir, Vineeth Sama, Shaun A Nguyen, Mohamed Abdelwahab","doi":"10.1002/ohn.1114","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To provide an updated evaluation of clinical effectiveness and sequelae of maxillomandibular advancement surgery in obstructive sleep apnea.</p><p><strong>Data sources: </strong>PubMed, Scopus, CINAHL.</p><p><strong>Review methods: </strong>Included studies described patients with obstructive sleep apnea that completed maxillomandibular advancement with any reported sequelae. Meta-analysis of proportions, regressions, and single means with 95% confidence interval were calculated using random and fixed effects models.</p><p><strong>Results: </strong>Of 380 unique abstracts reviewed, a total of 31 studies (n = 1597) were included in meta-analysis. Maxillomandibular advancement patients showed significant improvements in apnea-hypopnea index (AHI), respiratory disturbance index (RDI), SpO<sub>2</sub> Nadir, Epworth sleepiness scale (ESS), and body-mass index (BMI) by -41.87/h [-49.86 to -33.89], -46.24/h [-62.18 to -30.29], 6.29% [3.42 to 12.08], -8.69 [-11.54 to -5.83], and -0.74 kg/m<sup>2</sup> [-1.35 to -0.12], respectively. Sequelae with the greatest incidence were early lower facial numbness (83.40%), late lower facial numbness at less and greater than 1 year follow-up (66.51%, 32.73% respectively), and hardware removal (21.99%). There was a positive correlation between both preoperative BMI and length of hospital stay (r = 0.81, P = .052) and age and lower facial numbness (r = 0.42, P = .196). A negative correlation was found between Change in AHI and time to follow up (r = 0.75, P = .087). No major complications nor mortality were reported.</p><p><strong>Conclusion: </strong>Maxillomandibular advancement has the highest success rate for obstructive sleep apnea among current surgical treatments, with most sequelae being transient. Early lower facial numbness should be highlighted preoperatively to ensure informed decision-making. Further research should be geared towards reducing this risk.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":"172 4","pages":"1142-1154"},"PeriodicalIF":2.6000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Otolaryngology- Head and Neck Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/ohn.1114","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/7 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"OTORHINOLARYNGOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: To provide an updated evaluation of clinical effectiveness and sequelae of maxillomandibular advancement surgery in obstructive sleep apnea.
Data sources: PubMed, Scopus, CINAHL.
Review methods: Included studies described patients with obstructive sleep apnea that completed maxillomandibular advancement with any reported sequelae. Meta-analysis of proportions, regressions, and single means with 95% confidence interval were calculated using random and fixed effects models.
Results: Of 380 unique abstracts reviewed, a total of 31 studies (n = 1597) were included in meta-analysis. Maxillomandibular advancement patients showed significant improvements in apnea-hypopnea index (AHI), respiratory disturbance index (RDI), SpO2 Nadir, Epworth sleepiness scale (ESS), and body-mass index (BMI) by -41.87/h [-49.86 to -33.89], -46.24/h [-62.18 to -30.29], 6.29% [3.42 to 12.08], -8.69 [-11.54 to -5.83], and -0.74 kg/m2 [-1.35 to -0.12], respectively. Sequelae with the greatest incidence were early lower facial numbness (83.40%), late lower facial numbness at less and greater than 1 year follow-up (66.51%, 32.73% respectively), and hardware removal (21.99%). There was a positive correlation between both preoperative BMI and length of hospital stay (r = 0.81, P = .052) and age and lower facial numbness (r = 0.42, P = .196). A negative correlation was found between Change in AHI and time to follow up (r = 0.75, P = .087). No major complications nor mortality were reported.
Conclusion: Maxillomandibular advancement has the highest success rate for obstructive sleep apnea among current surgical treatments, with most sequelae being transient. Early lower facial numbness should be highlighted preoperatively to ensure informed decision-making. Further research should be geared towards reducing this risk.
期刊介绍：
Otolaryngology–Head and Neck Surgery (OTO-HNS) is the official peer-reviewed publication of the American Academy of Otolaryngology–Head and Neck Surgery Foundation. The mission of Otolaryngology–Head and Neck Surgery is to publish contemporary, ethical, clinically relevant information in otolaryngology, head and neck surgery (ear, nose, throat, head, and neck disorders) that can be used by otolaryngologists, clinicians, scientists, and specialists to improve patient care and public health.
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