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Sleep-disordered breathing (SDB) in children could be resolved by adenotonsillectomy (T&A). However, incomplete results are often noted post-surgery. Because of this partial resolution, long-term follow-up is needed to monitor for reoccurrence of SDB, which may be diagnosed years later through reoccurrence of complaints or in some cases, through systematic investigations. Children undergoing T&A often have small upper airways. Genetics play a role in the fetal development of the skull, the skull base, and subsequently, the size of the upper airway. In non-syndromic children, specific genetic mutations are often unrecognized early in life and affect the craniofacial growth, altering functions such as suction, mastication, swallowing, and nasal breathing. These developmental and functional changes are associated with the development of SDB. Children without genetic mutations but with impairment of the above said functions also develop SDB. When applied early in life, techniques involved in the reeducation of these functions, such as myofunctional therapy, alter the craniofacial growth and the associated SDB. This occurs as a result of the continuous interaction between cartilages, bones and muscles involved in the growth of the base of the skull and the face. Recently collected data show the impact of the early changes in craniofacial growth patterns and how these changes lead to an impairment of the developmental functions and consequent persistence of SDB. The presence of nasal disuse and mouth breathing are abnormal functions that are easily amenable to treatment. Understanding the dynamics leading to the development of SDB and recognizing factors affecting the craniofacial growth and the resulting functional impairments, allows appropriate treatment planning which may or may not include T&A. Enlargement of lymphoid tissue may actually be a consequence as opposed to a cause of these initial dysfunctions., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Sleep disordered breathing syndromes in pediatric patients can lead to adverse effects in the cardiovascular system, neurocognitive function, growth, and behavior. These syndromes occur more frequently in patients with craniofacial disorders. A high index of suspicion as well as early recognition, detection, and treatment of these syndromes are considered integral to care of children with craniofacial disorders., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Skeletal surgeries, specifically orthognathic procedures are an integral part of the treatment regimen for patients with airway issues. As evaluation mechanisms for, research into, and treatment options for, patients with airway issues have become refined, so have the techniques used to treat them become more focused and less prescriptive. The diagnosis for the severity of the airway compromise has also undergone an evolutionary change, with the diagnostic criteria becoming more restrictive and the equipment for diagnosing them more sophisticated.

Purpose: This study evaluated the effectiveness of uvulopalatopharyngoplasty (UPPP) with mortised genioplasty and maxillomandibular advancement (MMA) for the treatment of patients with obstructive sleep apnea not controllable with appliances or continuous positive airway pressure., Methods: Forty patients with obstructive sleep apnea were evaluated retrospectively. Thirty-three patients underwent combined UPPP and a modified mortised genioglossus advancement. Patients who had specific indications for MMA underwent combined procedures, eliminating staging of multiple surgeries. Seven patients were in this group. All patients were evaluated preoperatively and postoperatively with polysomnography to evaluate the efficacy of the treatment., Results: Mean respiratory distress indices (RDI) and nadir oxyhemoglobin desaturation values were significantly improved with each of the therapies despite many patients having body mass indices significantly greater than the average quoted in other studies. Patients with moderate sleep apnea (RDI, 21 to 40) who underwent UPPP/genioglossus advancement did very well, with 86% of patients achieving success. Patients who underwent MMA all decreased their RDI by at least 56% and had an average improvement of 86%., Conclusions: The UPPP/mortised genioglossus advancement is effective for the treatment of obstructive sleep apnea. Maxillomandibular advancement is effective for treating severe sleep apnea and may, in some cases, be indicated in combination with UPPP/mortised genioglossus advancement to avoid multiple procedures. Surgical reconstruction of the upper airway is a reasonable approach to the treatment of patients with obstructive sleep apnea, and can be approached more directly to minimize repeated surgical intervention., (Copyright 2001 American Association of Oral and Maxillofacial Surgeons)

Purpose: The goal of this study was to evaluate the patient's perception of the facial appearance after maxillomandibular advancement (MMA) surgery for obstructive sleep apnea syndrome (OSAS)., Patients and Methods: During a 14-month period, 58 patients underwent MMA for OSAS. All of the patients underwent preoperative and postoperative cephalometric analysis. Between 6 and 12 months after surgery, a questionnaire was mailed to each patient. The questionnaire asked the patient to evaluate subjectively their postoperative facial appearance. Visual analog scale ([VAS] 0 to 10) was used to assess the extent of the facial changes., Results: Forty-four (76%) patients (39 men, 6 women) responded to the questionnaire. Cephalometric analysis revealed that 40 patients had maxillomandibular protrusion postoperatively. Forty-two (96%) of the 44 patients reported changes in their facial appearance (VAS, 4.8 +/- 2.5). Twenty-four (55%) patients reported favorable facial changes (ie, they were more attractive [15 patients] and/or more youthful). Fourteen patients gave neutral responses (ie, they were no more or no less attractive). Four patients gave unfavorable responses (ie, they were less attractive after surgery)., Conclusion: The results suggest that most patients who underwent MMA for OSAS noted moderate changes in their facial appearance. Despite significant maxillomandibular protrusion based on the postoperative cephalometric analysis, more than 90% of the patients gave either positive or neutral responses to the changes in their facial appearance.

Purpose: The purpose of this study was to investigate the success of a staged surgical reconstruction of the upper airway for treatment of obstructive sleep apnea syndrome., Patients and Methods: Thirty-five patients with obstructive sleep apnea syndrome documented by nocturnal polysomnography were treated surgically with a staged protocol for reconstruction of the upper airway. All patients were evaluated preoperatively by a history and physical examination, including fiberoptic nasopharyngoscopy, oropharyngoscopy, and hypopharyngoscopy; cephalometric analysis; and laboratory polysomnography. All patients included were diagnosed with type II obstruction, with collapse at the oropharyngeal and hypopharyngeal levels. Stage I reconstruction consisted of uvulopalatopharyngoplasty (UPPP) by the Fujita method and anterior mandibular osteotomy (AMO) or inferior sagittal osteotomy (ISO) with genioglossus muscle advancement. If stage I was unsuccessful, patients were advanced to stage II and stage III, if necessary. Stage II reconstruction consisted of bimaxillary advancement with rigid fixation. Stage III reconstruction consisted of hyoid myotomy and advancement., Results: All patients underwent follow-up nocturnal polysomnography 4 to 6 months after the last surgical procedure. Most patients responded positively to stage I reconstruction (respiratory disturbance index [RDI] < 20, with O2 saturation 95+%). Twenty-four patients (69%) had postoperative RDIs of 20 or less. Of these, 11 patients (31%) had an RDI of five or fewer; seven patients (20%) had an RDI between 6 and 10, and six patients (17%) had an RDI between 10 and 20. The mean preoperative RDI was 53, and the mean postoperative RDI was 19. Of the three patients who elected to proceed to stage II reconstruction, all had a postoperative RDI of 10 or less (two patients [67%] had an RDI of 5 or less, and one patient [33%] had an RDI of 6 to 10)., Conclusion: This study showed that properly selected patients with obstructive sleep apnea syndrome benefit from a staged reconstruction of the upper airway.

Hyoid bone suspension with inferior myotomy has been shown to be a successful technique in the treatment of obstructive sleep apnea. However, little mention is made in the literature concerning the details of the surgical procedure. Anatomic details have been given even less attention. This article addresses the regional anatomy, surgical technique, and materials for suspension of the hyoid bone, along with newer modifications of the procedure. Potential risks and complications are also discussed.

Purpose: This study examined the long-term skeletal stability of relatively large maxillomandibular advancement surgery in the treatment of obstructive sleep apnea syndrome (OSAS)., Materials and Methods: The presurgical, immediate (< 1 month), and long-term (> 12 months) postsurgical cephalometric radiographs of 19 patients undergoing maxillomandibular advancement with simultaneous genioplasty for OSAS were studied. The cephalometric measurements and calculations were performed using a commercial cephalometric software., Results: Maxillary and mandibular advancement seems to be stable in the horizontal and vertical planes over the long term. There was no significant correlation between the amount of surgical advancement and the amount of postsurgical instability, with the exception of gonion in the vertical plane., Conclusion: The results from this study indicate that large surgical advancements in OSAS patients result in relatively stable repositioning of the maxilla and mandible over the long term.

This study analyzes changes in the anteroposterior dimension of the oropharynx as determined from lateral cephalometric radiographs on 26 patients who have undergone mandibular advancement. Increases in the sagittal dimensions of the oropharynx were unpredictable and tended to decrease with time, suggesting that mandibular advancement may be an unreliable method of treating obstructive sleep apnea. The most stable long-term results were found in those cases with narrowing of the oropharynx preoperatively.

A surgical protocol for dynamic upper airway reconstruction in the treatment of obstructive sleep apnea syndrome is presented. Two hundred thirty-nine consecutively treated patients were evaluated. All patients underwent a presurgical evaluation that included a physical examination, fiberoptic pharyngoscopy, cephalometric analysis, and polygraphic monitoring. The goal of the presurgical evaluation was to document sleep apnea and isolate the area of obstruction. The treatment was then directed to the obstructive site. The surgical protocol included two phases. Phase 1 was a conservative approach and included uvulopalatopharyngoplasty and/or mandibular osteotomy with genioglossus advancement-hyoid myotomy and suspension. Polysomnography was repeated at 6 months and patients with unsuccessful surgical results were offered maxillary-mandibular advancement osteotomy. Results were based on the postoperative polysomnograms, and included assessing changes in both sleep architecture and sleep-disordered breathing. The surgical results were compared with results in patients who were using nasal continuous positive airway pressure. The surgical success rate for the 239 patients entered into phase 1 therapy was 61% (145 patients). Twenty-four patients who failed phase 1 treatment elected phase 2 treatment. The surgical success rate of this phase was 100%.

Forty patients with documented obstructive sleep apnea syndrome (OSAS) were evaluated following maxillary and mandibular osteotomies (MMO). All patients were evaluated before and after surgery by a physical examination, fiberoptic pharyngoscopy, cephalometric analysis, and polysomnography. Ninety-seven percent of the patients responded to the surgical treatment, based on the polysomnogram. The present indications for MMO are severe OSAS, morbid obesity, and severe mandibular deficiency.

Obstructive sleep apnea syndrome is a relatively common disorder with potentially serious psychologic and physiologic consequences. A comprehensive method of evaluation is described. Presurgical tests are mandatory in order to logically direct surgical treatment. Current surgical treatment and new techniques are discussed.

Fifty-five patients with obstructive sleep apnea syndrome (OSAS) were evaluated following inferior mandibular osteotomy with hyoid myotomy and suspension. Patients were objectively examined by polysomnography before and 6 months following the surgical procedure. Thirty-seven patients (67%) had a good response from surgery, and 18 patients (33%) were considered nonresponders. Lung disease, mandibular deficiency, and obesity were factors found to affect the success of surgical treatment.

Twenty-three patients with obstructive sleep apnea syndrome (OSAS) documented by polysomnography underwent maxillomandibular advancement via Le Fort I, and sagittal ramus split osteotomies followed by rigid fixation with miniplates and bicortical screws. Partial turbinectomies and septal reconstruction were simultaneously performed. Pre- and post-operative cephalometric radiographs were analyzed by computer. Hyoid position and posterior airway space changes did not correlate with clinical success. The surgical success (respiratory disturbance index less than 10) with maxillomandibular advancement was 65%. The total desaturations below 90% greatly decreased. Ninety-six percent of patients were subjectively and objectively improved.