Oral appliances and maxillomandibular advancement surgery: an alternative treatment protocol for the obstructive sleep apnea-hypopnea syndrome

J Oral Maxillofac Surg. 2006 Jun;64(6):886-91. doi: 10.1016/j.joms.2005.11.041.


Purpose: The present study comprises a retrospective evaluation of the potential application of mandibular repositioning appliance (MRA) therapy preceding maxillomandibular advancement (MMA) surgery in the treatment of the Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS). Our initial experiences with a new surgical protocol, in which MRA therapy serves as a predictor for success of MMA surgery, are reported.

Patients and methods: Forty-three consecutive patients with OSAHS treated with MRA therapy were considered for inclusion (mean+/-SD; Apnea-Hypopnea Index [AHI]=27+/-20; age=53+/-9 years). All patients displaying a substantial improvement in their AHI with MRA therapy (ie,>50% reduction) who preferred surgical rather than "prosthetic" advancement of the mandible were offered MMA surgery. Accordingly, 4 out of 43 patients were treated with MMA surgery. The AHI was used as the primary outcome measure, with MMA surgery being considered successful in case of a postoperative AHI <5.

Results: All 4 patients included displayed substantial improvement in their AHI following MRA therapy. Moreover, in 3 patients MRA therapy resulted in a post-treatment AHI <or=5. With respect to the primary outcome measure, successful OSAHS management was attained in all 4 patients following MMA surgery.

Conclusion: Results from the 4 patients included in the present study suggest that MRA therapy might be a good predictor for the success of MMA surgery in OSAHS management. Although confirmation in a larger study sample is indicated, we conclude that patients with a substantial reduction in baseline AHI with MRA therapy appear to be candidates for MMA surgery.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Clinical Protocols
  • Humans
  • Jaw Fixation Techniques / instrumentation
  • Mandibular Advancement / instrumentation*
  • Mandibular Advancement / methods*
  • Maxilla / surgery*
  • Middle Aged
  • Orthodontic Appliances*
  • Preoperative Care
  • Prognosis
  • Retrospective Studies
  • Sleep Apnea, Obstructive / surgery
  • Sleep Apnea, Obstructive / therapy*
  • Treatment Outcome