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Maxillomandibular Advancement for OSA: Serious Complications and Failures
Kasey Li1, Christian Guilleminault2
1Sleep Apnea Surgery Center, 1900 University Avenue, Suite 105, East Palo Alto, CA, USA.
L' Orthodontie Francaise
|January 27, 2023
Summary
Maxillomandibular advancement (MMA) for obstructive sleep apnea (OSA) can fail, leading to complications. Careful surgical planning and fixation are crucial for successful MMA outcomes and to prevent severe long-term issues.
Area of Science:
- Oral and Maxillofacial Surgery
- Sleep Medicine
- Surgical Complications
Background:
- Maxillomandibular advancement (MMA) is a surgical procedure to treat obstructive sleep apnea (OSA).
- Complications and failures following MMA performed at other institutions necessitate further analysis.
Purpose of the Study:
- To analyze patient outcomes, specifically complications and failures, of MMA surgery performed elsewhere.
- To identify factors contributing to MMA failure and associated sequelae.
Main Methods:
- Retrospective analysis of 16 patients seeking second opinions for MMA complications over five years.
- Review of clinical records, including radiography (plane radiography and CBCT), photographs, and examinations.
Main Results:
- 13 of 16 patients experienced surgical failure, with advancement ranging from -4 to 5 mm.
- 11 patients required additional surgeries due to complications such as hardware failure, bone displacement, non-union, pain, nerve injury, and malocclusion.
- Specific complications included hardware failure (10), bone segment displacement (8), mandibular non-union (8), maxillary non-union (2), chronic pain (5), facial nerve injury (2), lip/chin anesthesia (5), and malocclusion (4).
Conclusions:
- MMA can have unpredictable outcomes, including failure to improve OSA and severe long-term complications.
- Precise surgical execution, adequate skeletal advancement, and stable fixation are essential for successful MMA outcomes.
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