Should Mandibular Symphyseal Distraction Osteogenesis be considered in OSA Surgery?

Area of Science:

• Otolaryngology
• Sleep Medicine
• Maxillofacial Surgery

Background:

• Surgical maxillary expansion is a common treatment for obstructive sleep apnea (OSA).
• Over-expansion can lead to maxillary-mandibular mismatch, prompting consideration of mandibular symphyseal distraction osteogenesis (MSDO).
• The comparative airway impact of different surgical expansion techniques requires further analysis.

Purpose of the Study:

• To evaluate the airway impact of Endoscopically-Assisted Surgical Expansion (EASE) versus Distraction Osteogenesis Maxillary Expansion (DOME).
• To determine if MSDO is necessary when employing advanced maxillary expansion techniques for OSA.

Main Methods:

• Analysis of 20-year experience with MSDO and surgical maxillary expansion.
• Utilized computational fluid dynamic (CFD) data to compare airway impact of EASE and DOME.
• Assessed changes in nasal, retropalatal, oropharyngeal, and hypopharyngeal airway resistance.

Main Results:

• EASE demonstrated significantly greater reductions in airway resistance across all measured segments compared to DOME.
• EASE achieved 12-fold reduction in nasal and retropalatal resistance, 10-fold in oropharyngeal, and 8-fold in hypopharyngeal.
• DOME resulted in only a 3-fold reduction in resistance for all segments.

Conclusions:

• EASE is a more effective airway-centric surgical expansion technique for OSA.
• The superior efficacy of EASE minimizes the need for excessive maxillary widening and eliminates the necessity for MSDO.
• Current data does not support mandibular widening as a primary method for improving OSA.