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Does Maxillomandibular Advancement Surgery Normalize the Upper Airway Dimensions?

Hye Sung Wilhelm Kim1, Sungmin Cha2, Jin-Young Choi1

  • 1Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University.

The Journal of Craniofacial Surgery
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PubMed
Summary

Maxillomandibular advancement (MMA) surgery significantly enlarges the upper airway in obstructive sleep apnea (OSA) patients. However, minimal airway cross-sectional areas may not fully normalize compared to controls.

Keywords:
Airway dimensionmaxillomandibular advancementobstructive sleep apnea

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Area of Science:

  • Dentistry
  • Otolaryngology
  • Sleep Medicine

Background:

  • Obstructive sleep apnea (OSA) is a common condition characterized by upper airway collapse.
  • Maxillomandibular advancement (MMA) is a surgical procedure to treat OSA by expanding the airway.
  • Understanding the dimensional changes in the upper airway after MMA is crucial for treatment efficacy.

Purpose of the Study:

  • To compare upper airway dimensions after conventional MMA (cMMA) and modified MMA (mMMA) in adult OSA patients.
  • To evaluate the extent of airway enlargement and normalization relative to a control group.
  • To assess the impact of MMA on airway length, volume, and cross-sectional areas.

Main Methods:

  • Retrospective analysis of cone-beam computed tomography (CBCT) scans from OSA patients (cMMA n=12, mMMA n=7) and controls (n=19).
  • Measurements included airway length, nasopharyngeal, oropharyngeal, and total airway volumes (AV), and mean/minimal retropalatal and retroglossal cross-sectional areas (CSAs).
  • Presurgical (T0) and postsurgical (T1) scans were compared within and between groups.

Main Results:

  • Both cMMA and mMMA significantly increased mandibular and maxillary positions (SNA, SNB).
  • MMA resulted in reduced airway length and increased nasopharyngeal volume in both surgical groups.
  • Total airway volume and mean CSA increased significantly in cMMA; minimal CSAs increased in both groups but remained smaller than controls post-surgery.

Conclusions:

  • MMA effectively enlarges the upper airway in OSA patients, improving oropharyngeal dimensions.
  • While MMA provides substantial airway improvement, minimal retropalatal and retroglossal CSAs may not fully normalize to control levels.
  • Functional airway improvement after MMA can occur even without complete dimensional normalization.