Comparison of Surgical Effectiveness Between Conventional and Modified Maxillomandibular Advancement in Adult Patients With Obstructive Sleep Apnea

The purpose of this study was to compare the surgical effectiveness of conventional maxillomandibular advancement (cMMA) and modified MMA (mMMA) in adult patients with obstructive sleep apnea (OSA). The subjects were 24 adult OSA patients who underwent either cMMA (n=11) or mMMA (n=13: extraction of maxillary and mandibular premolars, Le Fort I osteotomy with segmental osteotomy for advancement of the posterior maxillary segment, and bilateral sagittal split ramus osteotomy with segmental osteotomy for total advancement of the mandible). Polysomnographic (PSG) variables and cephalometric skeletodental, soft-tissue, hyoid/tongue, and upper-airway (UA) variables obtained before surgery (T0) and after surgery (T1) were statistically analyzed. At T0, the mMMA group exhibited higher apnea-hypopnea index (AHI) and respiratory disturbance index (RDI) values (both P<0.05), a more forward-positioned maxilla and mandible (SNA and SNB; both P<0.05), greater incisor proclination (U1 to SN, P<0.05; IMPA, P<0.01), more protrusive upper and lower lips (upper lip to E-plane and lower lip to E-plane, both P<0.05), a more forward-positioned genial tubercle (H-RGN, P<0.01), and a greater tongue length (TGL, P<0.05). At T1, no significant differences in the position of the maxilla and mandible, incisor inclination, or lip protrusion were found between the 2 groups. In addition, PSG parameters and UA variables did not differ between the 2 groups, indicating comparable surgical outcomes. These findings suggest that mMMA may be an effective surgical option for adult OSA patients with dentoalveolar and/or lip protrusion.