Maxilla management in “phase II” skeletal surgery for obstructive sleep apnea

This study investigates the management of patients with obstructive sleep apnea (OSA) who have previously undergone palatal surgery and subsequently undergo maxillomandibular advancement (MMA). The research entails a retrospective analysis of phase II MMA cases from 2017 to 2022. Data encompassing demographics, clinical profiles, pre- and post-operative polysomnographic and radiological findings, surgical techniques, and complications were collected. Out of the 14 patients studied, conservative vestibular approaches were applied universally, with four cases necessitating the sectioning of descending palatine arteries. Results indicate an average maxillary sagittal advancement of 10.07 mm, a mean counterclockwise rotation of the maxillary occlusal plane at 9.35°, and a decline in apnea-hypopnea index from 45.5 to 4.5 events per hour. Surgical success and cure rates were 93.3% and 40%, respectively, with no major complications observed throughout the 45-month follow-up. This study underscores the safe and efficacious application of MMA in OSA patients with prior palatal surgery, offering valuable insights into their management.