Virtual surgical planning improves surgical outcome measures in obstructive sleep apnea surgery

Laryngoscope. 2014 May;124(5):1259-66. doi: 10.1002/lary.24501. Epub 2013 Dec 6.


Objectives/hypothesis: Determine the feasibility and accuracy of using virtual surgical planning (VSP) to direct the surgical and polysomnography (PSG) outcomes of patients with obstructive sleep apnea (OSA).

Study design: Prospective case series.

Methods: Skeletal and soft tissue dimensions were measured from computed tomography (CT) to include posterior airway space (PAS) diameters at the occlusal (PAS-O) and mandibular (PAS-M) plane, position of the maxilla, and tooth-to-lip distance. All patients underwent an in-lab attended PSG whereby apnea-hypopnea index (AHI), respiratory disturbance index (RDI), and lowest oxyhemoglobin saturation percent (LSAT) were measured preoperatively and at least 9 months postoperatively.

Results: Four patients with OSA demonstrated a mean AHI and RDI of 60.1 and 69.5 events per hour, respectively. The mean preoperative LSAT was 76%. Mean CT-based measures for PAS-O and PAS-M were 3.08 mm and 9.03 mm, respectively. VSP was used to direct the amount of advancement and impaction in maxillomandibular advancement (MMA) surgery. The mean PAS-O and PAS-M postoperative measures significantly increased to 8.15 and 14 mm (P < .004), whereas the mean tooth-to-lip relationship stayed the same, 3.17 to 3.18, P = .98. The AHI and RDI significantly improved to 2.83 and 4.5 events per hour, respectively, P = .03, whereas the LSAT improved from 76% to 87%.

Conclusions: VSP for MMA in OSA patients is feasible and safe while offering improvements in the predictability of airway change and tooth-to-lip measures.

Keywords: Obstructive sleep apnea; radiology; virtual surgical planning.

MeSH terms

  • Adult
  • Female
  • Humans
  • Male
  • Mandibular Advancement
  • Maxilla / surgery
  • Middle Aged
  • Orthognathic Surgical Procedures / methods*
  • Outcome Assessment, Health Care
  • Patient Care Planning*
  • Polysomnography
  • Prospective Studies
  • Sleep Apnea, Obstructive / diagnostic imaging*
  • Sleep Apnea, Obstructive / surgery*
  • Surgery, Computer-Assisted*
  • Tomography, X-Ray Computed*
  • User-Computer Interface*