Division of Sleep Surgery, Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, 801 Welch Road, Standford, CA, 94305, USA.
Division of Oral and Maxillofacial Surgery, Kaohsiung Medical University Hospital, No. 100 Tzyou 1st Road, Kaohsiung, 80708, Taiwan.
Clin Oral Investig. 2020 Mar;24(3):1359-1367. doi: 10.1007/s00784-019-03017-5. Epub 2019 Jul 22.
Maxillomandibular advancement (MMA) confers consistent and high rates of surgical success for obstructive sleep apnea (OSA). In the era of value-based medicine, identifying factors that affect the stability of rigid fixation and allow rapid return to function are important targets for improvement. The aim of this study was to identify patient and surgical factors associated with mandibular sagittal split outcomes associated with optimal postoperatively skeletal stability.
Retrospective cohort study.
Forty-six subjects (43 males and 3 females) with postoperative CT scans including three-dimensional reconstruction from which mandibular split patterns could be analyzed were enrolled. Patient factors (age and polysomnographic measures) and surgical factors (extent of osteotomy prior to controlled fracture) were assessed. Outcome measures include (1) bone thickness for rigid fixation and (2) area of passive bony overlap after advancement.
Age and severity of disease did not contribute significantly to optimal mandibular split patterns. For optimal area for passive bony overlap and thickness of buccal and lingual plates for rigid fixation, the most important factors are related to surgical technique.
Anterior osteotomy just to the midline of inferior border and horizontal osteotomy to the mandibular foramen are associated with split patterns that result in optimal rigid fixation and passive bony overlap for OSA patients undergoing MMA.
Optimal surgical technique has the most significant influence in allowing rapid return to function after MMA in patients with OSA.
下颌骨水平截骨术（MMA）为阻塞性睡眠呼吸暂停（OSA）提供了一致且高成功率的治疗。在以价值为基础的医学时代，确定影响刚性固定稳定性并允许快速恢复功能的因素是改善的重要目标。本研究旨在确定与术后骨骼稳定性最佳相关的下颌矢状劈开结果相关的患者和手术因素。
回顾性队列研究。
共纳入 46 名患者（43 名男性和 3 名女性），术后 CT 扫描包括三维重建，可从中分析下颌分裂模式。评估患者因素（年龄和多导睡眠图测量）和手术因素（在受控骨折前的截骨范围）。主要观察指标包括：（1）刚性固定的骨厚度；（2）推进后的被动骨重叠面积。
年龄和疾病严重程度对最佳下颌分裂模式没有显著影响。对于最佳的被动骨重叠面积和颊舌板的刚性固定骨厚度，最重要的因素与手术技术有关。
在下颌骨下缘中线前方和下颌骨孔的水平截骨与导致 OSA 患者 MMA 后最佳刚性固定和被动骨重叠的分裂模式有关。
对于 OSA 患者，最佳手术技术对 MMA 后快速恢复功能具有最重要的影响。
