University of Mondragon, Mondragon, Guipuzcoa, Spain.
Pneumology Service, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Bizkaia, Spain.
J Clin Sleep Med. 2024 Mar 1;20(3):371-379. doi: 10.5664/jcsm.10874.
Maxillomandibular advancement surgery (MMA) is a therapeutic option for obstructive sleep apnea (OSA). The main objective of this study was to determine the impact of MMA on the physical and airflow characteristics of the upper airway based on data obtained by computational fluid dynamics (CFD) and to correlate these data with polysomnography parameters. Other objectives included the identification of presurgical variables that could help avoid surgeries likely to have a low success rate.
This was a retrospective observational study of 18 patients with moderate-severe OSA who underwent MMA. Polysomnography and computed axial tomography imaging were performed before and after the surgery. Three-dimensional models for CFD study were made based on the images obtained.
MMA achieved an average increase in airway volume of 43.75%, with a mean decrease in the maximum airway velocity of 40.3%. We found significant correlations between improved apnea-hypopnea index values and both the increase in airway volume and decrease in maximum airway speed. Patients with a maximum velocity of less than 7.2 m/s before the intervention had a high rate of surgical failure (43%).
MMA generates a significant increase in the volume of the upper airway, which was associated with improved flow conditions in the CFD simulation. These findings also correlated with improved polysomnography parameters. Thus, CFD simulation on three-dimensional anatomical models of patients with OSA could contribute to the better selection of candidates for MMA.
Furundarena-Padrones L, Cabriada-Nuño V, Brunsó-Casellas J, et al. Correlation between polysomnographic parameters and volumetric changes generated by maxillomandibular advancement surgery in patients with obstructive sleep apnea: a fluid dynamics study. . 2024;20(3):371-379.
下颌骨前移术（MMA）是治疗阻塞性睡眠呼吸暂停（OSA）的一种治疗选择。本研究的主要目的是基于计算流体动力学（CFD）获得的数据，确定 MMA 对上气道的物理和气流特性的影响，并将这些数据与多导睡眠图参数相关联。其他目标包括确定可能有助于避免手术成功率可能较低的手术的术前变量。
这是一项回顾性观察研究，共纳入 18 例接受 MMA 的中重度 OSA 患者。在手术前后进行多导睡眠图和计算机轴向断层扫描成像。根据获得的图像制作 CFD 研究的三维模型。
MMA 平均使气道容积增加了 43.75%，最大气道速度平均降低了 40.3%。我们发现，呼吸暂停低通气指数值的改善与气道容积的增加和最大气道速度的降低均有显著相关性。干预前最大速度小于 7.2 m/s 的患者手术失败率较高（43%）。
MMA 可显著增加上气道容积，这与 CFD 模拟中气流条件的改善相关。这些发现还与多导睡眠图参数的改善相关。因此，对 OSA 患者的三维解剖模型进行 CFD 模拟有助于更好地选择 MMA 候选者。
Furundarena-Padrones L, Cabriada-Nuño V, Brunsó-Casellas J, et al. Correlation between polysomnographic parameters and volumetric changes generated by maxillomandibular advancement surgery in patients with obstructive sleep apnea: a fluid dynamics study.. 2024;20(3):371-379.
