Search

Failing to address Obstructive Sleep Apnea (OSA) in Down Syndrome (DS) patients can have serious consequences, leading to increased mortality. Moreover, a notable portion of individuals find it challenging to tolerate Continuous Positive Airway Pressure (CPAP). Therefore, this study aims to share our experiences in treating adult DS patients with moderate to severe OSA who don't tolerate CPAP using various surgical approaches. A retrospective analytical study including 20 DS with moderate to severe/very severe OSA who had no tolerance to Continuous Positive Airway Pressure (CPAP) was conducted. Regarding the individual skeletal characteristics of each patient various orthognathic surgery techniques were performed. Two in-hospital polysomnographies (PSG) were undertaken for every patient; one before the surgical procedure, while another was performed between 6 and 60 months of the follow-up post-surgery period. Polysomnographic variables were analyzed in this study such as AHI, ODI, and T90, which all showed statistically significant improvement after surgery with a p value in the Wilcoxon test <0,01. These results have remained stable over time, with no recurrences of OSA observed over the five years of follow-up. Thus, orthognathic surgery may be the only viable option for individuals with DS who are unable to tolerate CPAP. • OSA and DS are strongly associated. • DS patients tolerate CPAP worse than non-syndromic ones. • Soft tissue surgery often leaves residual OSA. • Consider skeletal surgery for DS patients intolerant to CPAP. • Skeletal surgery has no higher morbidity in DS patients. [ABSTRACT FROM AUTHOR]

Bilateral internal ramus distraction (BIRD) is now part of select protocols for treating obstructive sleep apnea (OSA). Introducing a home monitoring protocol offers a valuable alternative to overnight laboratory polysomnography (PSG). The purpose of this study was to evaluate and compare OSA parameters obtained via home respiratory polygraphy (HRP) and hospital PSG in a cohort of patients undergoing mandibular distraction for OSA management. Hospital Universitario La Princesa (Madrid) researchers conducted a prospective cohort study with patients diagnosed with moderate (apnea-hypopnea index (AHI) = 15 to 30) to severe (AHI>30) OSA undergoing BIRD followed by LeFort maxillary osteotomy. Exclusion criteria were as follows: severe systemic diseases, central apneas, smoking, poor dental hygiene, or prior OSA interventions. The predictor variable was PSG and HRP techniques. The main outcome variable comprises a collection of OSA parameters, including the AHI, oxygen desaturation index (ODI), and time spent below 90% oxygen saturation (T90). These data were measured both before and after distraction, as well as after 6 mm, 9 mm, and 12 mm of mandibular distraction. The covariates were age, sex, cardiovascular risk parameters, and the Epworth sleepiness scale. Pearson's correlation analyzed AHI, ODI, and T90 values from PSG and HRP. Wilcoxon Signed Rank-Sum Test compared 2 distraction stages, and the Friedman Test evaluated 3 stages (P <.05). Multiple regression analysis assessed if covariates were independent risk factors for postoperative persistent OSA. The study included 32 patients (25% with moderate and 75% with severe OSA). Final AHI was 10.9 ± 8.9 (events/hour) with HRP, compared to 15.2 ± 13.4 with PSG (r = 0.7, P <.05). ODI was 9.0 ± 8.1 (des/h) with HRP and 8.7 ± 9.5 with PSG (r = 0.85, P <.05). T90 was 1.6 ± 2.2 with HRP and 1.3 ± 3.0 with PSG (r = 0.6, P <.05). Based on HRP data, AHI improved from D1 (34.0 ± 19.5) to D2 (20.8 ± 14.1) and D3 (12.5 ± 10.4) (P <.05). ODI decreased from D1 (26.1 ± 19.0) to D2 (16.0 ± 12.6) and D3 (9.4 ± 8.8) (P <.05). T90 reduced from D1 (8.2 ± 12.6) to D2 (4.1 ± 5.2) and D3 (1.9 ± 2.8) (P <.05). Multiple regression analysis of comorbidities produced nonsignificant results. Monitoring BIRD through HRP has demonstrated efficacy in yielding results that align with PSG. [ABSTRACT FROM AUTHOR]

Obstructive Sleep Apnea (OSA) is a significant health issue due to noncompliance with continuous positive airway pressure treatment. Therefore, evaluating alternative treatments is crucial. Analyze the impact of maxillomandibular advancement using bilateral internal ramus distraction (BIRD) on quality of life (QOL) in OSA patients. A prospective cohort study was conducted at the Oral and Maxillofacial Surgery Department of the University Hospital "La Princesa." The study included patients with moderate to severe OSA who were treated with the BIRD approach. Changes in measured variables were analyzed at three time points: before surgery (T1), after mandibular advancement (T2), and after maxillary advancement (T3). QOL changes measured by Quebec Sleep Questionnaire and the Epworth Sleepiness Scale. Secondary outcomes included: apnea-hypopnea index (AHI), oxygen desaturation index, and percentage of time with saturation below 90%. Age, sex, continuous positive airway pressure treatment, cephalometric variables and cardiovascular risk parameters were considered. Statistical analysis employed the Friedman test and χ2 test, with a significance level of P ≤.05. The study included 32 patients (22% with moderate OSA, 78% with severe OSA). Epworth Sleepiness Scale scores significantly decreased between T1 (13.4 ± 4.4) and T2 (5.8 ± 3.6) and T3 (1.9 ± 1.8) (P <.001). QOL improvements were observed in all domains: daytime sleepiness T1 (3.0 ± 1.3) T2 (5.4 ± 1.4) T3 (6.3 ± 1.0); diurnal symptoms T1 (2.5 ± 1.4) T2 (5.2 ± 1.3) T3 (6.2 ± 1.1); nocturnal symptoms T1 (2.5 ± 1.1) T2 (5.6 ± 1.1) T3 (6.5 ± 0.8); emotions T1 (2.6 ± 1.6) T2 (5.3 ± 1.4) T3 (6.5 ± 0.9); and social interaction T1 (2.5 ± 1.6) T2 (5.4 ± 1.6) T3 (6.3 ± 1.2) (P <.001). AHI decreased between T1 (47.9 ± 23.1) and T2 (14.4 ± 14.3) and T3 (4.7 ± 5.6) h−1 (P <.001), with a final cure rate of 81.2% (defined as final AHI<5 h−1). Oxygen desaturation index and percentage of time with saturation below 90% also showed significant reductions (P <.001). BIRD approach for OSA demonstrated a high cure rate and significant QOL improvements. It shows promise as an effective surgical option. Further research and long-term follow-up are needed. [ABSTRACT FROM AUTHOR]

Copyright of Revista Española de Cirugía Oral y Maxilofacial is the property of Sociedad Espanola de Cirugia Oral y Maxilofacial (SECOM) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Maxillomandibular advancement (MMA) can be effective for managing obstructive sleep apnoea (OSA); however, limited information is available on the predictor surgical variables. This study investigated whether normalization of the mandibular occlusal plane (MOP) was a determinant factor in curing OSA. Patients with moderate or severe OSA who underwent MMA were evaluated by preoperative and postoperative three-dimensional (3D) scans and polysomnograms. The postoperative value of MOP and the magnitude of skeletal advancement were the predictor variables; change in the apnoea–hypopnoea index (AHI) was the main outcome variable. Thirty-four subjects with a mean age of 41 ± 14 years and 58,8% female were analysed. The Epworth Sleepiness Scale (ESS) was 17.4 ± 5.4 and AHI was 38.3 ± 10.7 per hour before surgery. Postoperative AHI was 6.5 ± 4.3 per hour ( P < 0.001) with 52.94% of the patients considered as cured, and 47.06% suffering from a mild residual OSA with ESS 0.8 ± 1.4 ( P < 0.001). 3D changes revealed a volume increase of 106.3 ± 38.8%. The mandible was advanced 10.4 ± 3.9 mm and maxilla 4.9 ± 3.2 mm. MOP postoperative value was concluded to be the best predictor variable. Treatment planning should include MOP normalization and a mandibular advancement between 6 and 10 mm. The maxillary advancement would depend on the desired aesthetic changes and final occlusion. [ABSTRACT FROM AUTHOR]

Purpose: In this article, a new method of upper lip augmentation using a bilateral buccal fat pad flap is reported. This prospective study evaluated the changes in the upper lip that occur after maxillary surgery with concomitant mobilization of the bilateral buccal fat to improve upper lip projection. Materials and Methods: A bilateral pedicled buccal fat pad flap to fill the premaxilla, paranasal, and upper lip areas, in association with a Le Fort I osteotomy for maxillary advancement, was performed in 11 orthognathic surgical patients with a thin upper lip. Minimum follow-up was 12 months. Cone-beam computed tomograms from an i-CAT device (Imaging Sciences International, Hatfield, PA) were taken pre- and postoperatively and loaded into Dolphin software (Dolphin Imaging and Management Solutions, Chatsworth, CA) for analysis. Changes at the right upper incisor tip, upper lip anterior, upper inside, stomion superior, and subnasale were measured in each patient immediately before and 6 months after surgery. Dimensional changes of the upper lip were measured using lip length (from the subnasale to the stomion superior) and lip thickness (from the upper inside to the upper lip anterior). Results: The average maxillary advancement was 4.81 ± 2.47 mm, and the average vertical movement was 1.00 ± 1.75 mm; both were measured at the upper incisor tip. Upper lip movement, measured at the upper lip anterior, was 5.98 ± 2.46 mm (124.32% of maxillary advancement, mean data). Lip thickness increased 0.9 ± 0.19 mm, and lip length increased 0.77 ± 0.32 mm. The new upper lip contour was considered good to excellent in all cases. Conclusions: The technique described was useful to increase the projection, volume, and contour of the premaxilla, paranasal, and upper lip areas in orthognathic surgical patients. Moreover, it appeared to be useful to control the length shortening of the upper lip in all cases. [ABSTRACT FROM AUTHOR]