Persistent OSA After Maxillomandibular Advancement: Insights From Drug-Induced Sleep Endoscopy.

Area of Science:

• Otolaryngology
• Sleep Medicine
• Surgical Outcomes

Background:

• Obstructive sleep apnea (OSA) is a common condition characterized by recurrent upper airway collapse during sleep.
• Maxillomandibular advancement (MMA) is a surgical procedure to treat OSA by repositioning the upper and lower jaws.
• Persistent OSA after MMA necessitates further investigation into residual airway obstruction patterns.

Purpose of the Study:

• To evaluate the patterns of upper airway obstruction using drug-induced sleep endoscopy (DISE) in patients with persistent OSA following MMA.
• To characterize the specific sites of obstruction (tongue, velum, epiglottis, lateral walls) using the VOTE classification.

Main Methods:

• A cross-sectional study was conducted at an academic medical center.
• Drug-induced sleep endoscopy (DISE) was performed under propofol sedation in 24 adult patients with OSA and a postoperative apnea-hypopnea index (AHI) ≥ 5 events/h after MMA.
• Airway obstruction patterns were classified using the VOTE (Velum, Oral cavity, Tongue, Epiglottis) system in the supine position.

Main Results:

• Twenty-four patients underwent DISE, with a mean age of 46.4 years and 12% females. The mean time after MMA was 889 days, with a post-MMA AHI of 18.2 events/h.
• Tongue-related obstruction was the most frequent finding during DISE.
• Compared to a cohort without prior pharyngeal surgery, patients post-MMA showed less velum and oropharyngeal lateral wall obstruction but more epiglottis-related obstruction.

Conclusions:

• Upper airway obstruction in patients with persistent OSA after MMA involves multiple anatomical sites.
• Tongue-based obstruction is common, while epiglottis-related obstruction is more prevalent after MMA compared to individuals without previous pharyngeal surgery.