Impact of maxillomandibular atresia on the response to mandibular advancement devices in obstructive sleep apnea: a scoping review

Abstract Purpose To map the existing evidence on the impact of transverse craniofacial alterations on mandibular advancement device treatment outcomes in adults with obstructive sleep apnea, with the objective of identifying knowledge gaps and informing future research and clinical decision-making. Methods A systematic literature search was conducted in six databases. Additionally, gray literature sources were searched, and clinical trial registries, including ClinicalTrials.gov, were screened for RCT protocols. The reference lists of all included sources of evidence were also screened, and experts in the field were consulted. Results The literature search yielded a total of 1,508 references after duplicate removal. Nine studies and one conference report were found eligible for inclusion. The literature demonstrated heterogeneous associations between transverse craniofacial characteristics and mandibular advancement device treatment outcomes. Most studies ( n = 7) did not identify significant associations between isolated transverse craniofacial measurements and treatment response. Greater mandibular transverse dimensions were associated with better therapeutic outcomes in two studies, whereas one study reported better treatment response in individuals with smaller mandibular transverse dimensions. Reduced maxillary width and unfavorable anatomical balance were more frequently associated with greater obstructive sleep apnea severity or poorer treatment outcomes. Conclusions While some studies suggest that the response to mandibular advancement devices in obstructive sleep apnea is associated with transverse mandibular dimensions, most investigations have not identified this relationship. Future standardized and well-designed studies are needed to clarify the influence of this anatomical characteristic on the outcomes of this common treatment for obstructive sleep apnea.