Volumetric Analysis of the Pharynx in Patients with Obstructive Sleep Apnea (OSA) Treated with Maxillomandibular Advancement (MMA)

Overview

Journal Sleep Breath

Publisher Springer

Date 2012 May 8

PMID 22562291

Citations 17

Authors

Ana Celia Faria

Savio Nogueira da Silva-Junior

Luis Vicente Garcia

Antonio Carlos Dos Santos

Maria Regina Franca Fernandes

Francisco Verissimo De Mello-Filho

Affiliations

Soon will be listed here.

Abstract

Introduction: Maxillomandibular advancement (MMA) has been reported to be the most effective surgical treatment of obstructive sleep apnea (OSA). Most reports about MMA aim to confirm the efficiency of this treatment modality, but few describe the anatomical changes produced in the pharynx by the surgery. Thus, the objective of the present investigation was to quantify the anatomical changes of the pharynx that occur in patients with OSA after MMA surgery using magnetic resonance (MR).

Methods: Twenty patients with a polysomnographic diagnosis of OSA participated in the study. All patients were submitted to image acquisition by MR performed during wakefulness. Polysomnography and MR were performed preoperatively and 6 months after MMA. Volume analysis (in cubic millimeters) was performed as the sum of the areas multiplied by their thickness, with no intervals between sections. The pharyngeal air space of the region between the hard palate and the base of the epiglottis was divided into a retropalatal (RP) region and a retrolingual (RL) region.

Results: Postoperative MR showed a mean volumetric increase of 26.72 % in the RP region and of 27.2 % in the RL region.

Discussion: MMA increases the air space of the pharynx by expanding the facial skeletal structure to which the soft tissues of the pharynx and tongue are fixed, with a consequent reduction of collapsibility in the presence of negative pressure during inspiration. This reduced possibility of pharyngeal collapse may contribute to the reduction of obstructive events.

Citing Articles

A systematic review on 4D images of the upper airway in patients with OSA.

Degraeve M, Beij T, Lammens I, Vagenende T, De Meyer M, Aps J Sleep Breath. 2023; 28(2):597-606.

PMID: 38127191 DOI: 10.1007/s11325-023-02948-4.

Is maxillomandibular advancement an effective treatment for obstructive sleep apnea? Systematic literature review and meta-analysis.

Kiemle Trindade P, Nogueira V, Weber S Braz J Otorhinolaryngol. 2023; 89(3):503-510.

PMID: 37167845 PMC: 10196330. DOI: 10.1016/j.bjorl.2023.02.007.

Impact of counterclockwise rotation of the occlusal plane on the mandibular advancement, pharynx morphology, and polysomnography results in maxillomandibular advancement surgery for the treatment of obstructive sleep apnea patients.

Christino M, Vinha P, Faria A, Garcia D, De Mello-Filho F Sleep Breath. 2021; 25(4):2307-2313.

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Olszewska E, Woodson B Laryngoscope Investig Otolaryngol. 2019; 4(1):181-187.

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Sethukumar P, Kotecha B Breathe (Sheff). 2018; 14(3):e84-e93.

PMID: 30364490 PMC: 6196320. DOI: 10.1183/20734735.020118.

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