Li Kan, Zhao Tianyu, Liu Yukun, Cao Yang, Li Xiang, Gao Siyong, Sun Wei, Wang Tao, Zeng Lingchan, Feng Zhicai, Zheng Guangsen
Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China.
Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China.
Front Oral Health. 2025 Sep 11;6:1598511. doi: 10.3389/froh.2025.1598511. eCollection 2025.
BACKGROUND/PURPOSE: Maxillomandibular advancement (MMA) is widely used for treating obstructive sleep apnea (OSA) patients. However, conventional MMA may not be suitable for Eastern Asian patients with moderate or severe OSA, as it can lead to unsatisfactory postoperative facial appearance. Hence, modified MMA was reported. Our study aims to evaluate the therapeutic effects of modified MMA on OSA and patient satisfaction with facial appearance. In addition, anatomic and aerodynamic changes in the upper airway were explored.
This retrospective study included 13 patients with moderate or severe OSA. Overnight polysomnography and the Epworth Sleepiness Scale (ESS) scores were recorded before operation and 6 months after operation to evaluate therapeutic outcomes. Spiral CT scans were performed for all patients to reconstruct 3D configurations of the bony structures and the upper airway. Computational fluid dynamics was performed to analyze aerodynamic characteristics. In addition, correlations between bone segment movements and improvement in airway parameters were examined.
Modified MMA achieved successful therapeutic and esthetic outcomes in all cases. The apnea-hypopnea index (36.05 ± 17.68 vs. 5.72 ± 4.76, < 0.001) and the ESS (13.23 ± 8.9 vs. 6.23 ± 6.81 events/h, < 0.05) decreased significantly, while the lowest oxygen saturation (76.54 ± 10.26% vs. 84.77 ± 6.02%, < 0.05) improved greatly. Modified MMA significantly increased the total volume (6,716.55 ± 1,357.73 vs. 11,191.28 ± 2,563.79 mm, < 0.001) and the averaged cross-sectional area (117.38 ± 24.25 vs. 201.58 ± 35.76 mm, < 0.001) of the upper airway. After modified MMA, the pressure drop, gas velocity, and resistance in the upper airway were all significantly decreased ( < 0.05). Among all the maxillary and mandible sections, the strongest correlation was observed between the advanced movement of the anterior mandible segment and anatomical characteristics of the upper airway.
Modified MMA is an excellent therapeutic method for Eastern Asian patients with skeletal class Ⅱ dentomaxillofacial deformity suffering from moderate to severe OSA; it achieves a balance between esthetic improvement and therapeutic efficacy for OSA both anatomically and aerodynamically.
背景/目的：上颌下颌前移术（MMA）广泛应用于阻塞性睡眠呼吸暂停（OSA）患者的治疗。然而，传统的MMA可能不适用于患有中度或重度OSA的东亚患者，因为它可能导致术后面部外观不尽人意。因此，有改良MMA的报道。本研究旨在评估改良MMA对OSA的治疗效果以及患者对面部外观的满意度。此外，还探讨了上气道的解剖学和空气动力学变化。
这项回顾性研究纳入了13例中度或重度OSA患者。记录术前及术后6个月的夜间多导睡眠图和爱泼华嗜睡量表（ESS）评分，以评估治疗效果。对所有患者进行螺旋CT扫描，以重建骨结构和上气道的三维构型。进行计算流体动力学分析以分析空气动力学特征。此外，还检查了骨段移动与气道参数改善之间的相关性。
改良MMA在所有病例中均取得了成功的治疗和美学效果。呼吸暂停低通气指数（36.05±17.68比5.72±4.76，<0.001）和ESS（13.23±8.9比6.23±6.81次/小时，<0.05）显著降低，而最低血氧饱和度（76.54±10.26%比84.77±6.02%，<0.05）有显著改善。改良MMA显著增加了上气道的总体积（6716.55±1357.73比11191.28±2563.79mm，<0.001）和平均横截面积（117.38±24.25比201.58±35.76mm，<0.001）。改良MMA后，上气道的压降、气体流速和阻力均显著降低（<0.05）。在所有上颌和下颌节段中，观察到下颌前段的前移与上气道的解剖学特征之间的相关性最强。
改良MMA是治疗患有中度至重度OSA的东亚骨骼Ⅱ类牙颌面畸形患者的一种优秀治疗方法；它在美学改善和OSA治疗效果之间在解剖学和空气动力学方面都达到了平衡。
