Basic and patient-oriented researchQuality of Life Evaluation of Maxillomandibular Advancement Surgery for Treatment of Obstructive Sleep Apnea
Section snippets
Quality of Life Assessment
It has been quoted that “Quality of life in clinical medicine represents the functional effect of an illness and its consequent therapy on a patient, as perceived by the patient.”15 It has been a neglected dimension for many diseases as physicians have often been treating patients based on test results. Today, QOL is valued as an important aspect of patient care. QOL is done by assessing the various domains or components that make up the overall well-being of the patient. There are general and
Maxillomandibular Advancement
Maxillomandibular advancement surgery (MMA) is one of the most efficacious surgical procedures for OSA. It was first suggested as an alternative to tracheotomy for the treatment for OSA in 1979.20 MMA advocated by Riley and Powell meant a 10 mm advancement of the maxilla and mandible.21 The coordinated advancement of the maxilla and mandible results in retropalatal and retrolingual airway expansion.22, 23 The literature shows that this surgery yielded a 90% to 100% cure rate for the OSA21, 24,
Study Aim
The aim of this study is to measure the change in the QOL of patients undergoing maxillomandibular advancement (MMA) surgery. This change is quantified by the Functional Outcome of Sleep Questionnaire (FOSQ). The correlation of QOL improvement to other parameters such as PSG parameters, the amount of advancement during the orthognathic surgery and change in BMI was carried out.
Patients and Methods
We recruited consecutive OSA patients that were to undergo MMA at the Department of Oral and Maxillofacial Surgery (OMS), University of Alabama, Birmingham (UAB) for this Institutional Review Board (IRB)-approved study.
The inclusion criteria were: 1) patients with complete clinical, PSG, FOSQ, and radiographic records, and 2) patients who were treated with MMA with or without other adjunctive procedures. The exclusion criteria were: 1) patients who were still on nasal continuous positive airway
Results
Fifteen patients who had surgery between 2005 and 2007 were identified as suitable according to the criteria. They had a mean age of 47.93 years (range, 23 to 67 years). There were 13 Caucasian males and 2 Caucasian females. The patients had a mean preoperative BMI of 32.1 (range, 22.1 to 40.6).
The baseline preoperation PSG findings showed a mean preoperative AHI of 69.12 (range, 18.7 to 112.00) and a mean Lsat of 76.49% (range, 45 to 90.6). Fourteen patients had severe sleep apnea (AHI = >30)
MMA Success
This study supports the effectiveness of MMA as a treatment for obstructive sleep apnea, with an 86.7% success rate. Our patients had a mean preoperation BMI of 32.1 and a postoperation BMI of 31.5, which removed the chance that the success resulted from a significant loss of weight. The 2 patients that did not achieve success according to the AHI achieved large reductions in their apnea index but retained persistent hypopneas and also showed significant central apneas.
FOSQ
This is a
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