Department of Oral and Maxillofacial Surgery, Amsterdam UMC Location AMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, the Netherlands; Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
Department of Oral and Maxillofacial Surgery, Amsterdam UMC Location AMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, the Netherlands.
Sleep Med Rev. 2021 Jun;57:101471. doi: 10.1016/j.smrv.2021.101471. Epub 2021 Mar 17.
Multilevel surgery (MLS) and maxillomandibular advancement surgery (MMA) are two established options in surgical management of obstructive sleep apnea (OSA), which target different levels of airway obstruction. The objective of this review was to comparatively evaluate the clinical efficacy and safety of MMA and MLS in the treatment of OSA. MEDLINE and Embase databases were searched for studies on MMA and/or MLS in OSA patients. Twenty MMA studies and 39 MLS studies were identified. OSA patients who underwent MMA showed significant improvements in AHI, LSAT, ODI, and ESS by -46.2/h, 13.5%, -30.3/h, and -8.5, respectively. The pooled rates of surgical success and cure for MMA were 85.0% and 46.3%, respectively. Patients who underwent MLS showed significant improvements in AHI, LSAT, ODI, and ESS by -24.7/h, 8.7%, -19.1/h, and -5.8, respectively. The pooled surgical success and cure rates for MLS were 65.1% and 28.1%, respectively. The rates of major complication of MMA and MLS were 3.2% and 1.1%, respectively, and the rate of minor complication of MMA was higher than that of MLS. We conclude that both MMA and MLS are effective treatment options for OSA. Compared to MLS, MMA may be more effective in improving OSA. However, the complication rate of MMA is higher.
多平面手术（MLS）和下颌骨前徙术（MMA）是治疗阻塞性睡眠呼吸暂停（OSA）的两种既定方法，针对不同水平的气道阻塞。本综述的目的是比较评估 MMA 和 MLS 治疗 OSA 的临床疗效和安全性。我们在 MEDLINE 和 Embase 数据库中搜索了关于 MMA 和/或 MLS 治疗 OSA 患者的研究。共确定了 20 项 MMA 研究和 39 项 MLS 研究。接受 MMA 的 OSA 患者 AHI、LSAT、ODI 和 ESS 分别降低了-46.2/h、13.5%、-30.3/h 和-8.5。MMA 的手术成功率和治愈率分别为 85.0%和 46.3%。接受 MLS 的 OSA 患者 AHI、LSAT、ODI 和 ESS 分别降低了-24.7/h、8.7%、-19.1/h 和-5.8。MLS 的手术成功率和治愈率分别为 65.1%和 28.1%。MMA 和 MLS 的主要并发症发生率分别为 3.2%和 1.1%，MMA 的小并发症发生率高于 MLS。我们得出结论，MMA 和 MLS 都是 OSA 的有效治疗选择。与 MLS 相比，MMA 可能在改善 OSA 方面更有效。然而，MMA 的并发症发生率更高。
