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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4421_Библиотеки_им_академика_М_И_Перельмана.pdf
Maxillomandibular Advancement
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The case shows palatal expansion, which was performed to gain additional transverse width following
presurgical uprighting of the lower teeth on the basal
bone. (See . Figs.28.17, 28.18, 28.19, 28.20, and 28.21).
28.7.5 Case 4: High BMI andSevere OSA
A 54-year-old male with high BMI and severe OSA presented to our practice. The airway was diminished at the
soft palate region. The patient was CPAP-intolerant and
it was ineffective as a management modality. Because of
the patient’s high BMI, the patient was recommended to
seek weight loss prior to surgery. This weight change did
not decrease his AHI sufciently due to the fact that the
airway was still constricted at the soft palate region. No
change in the minimal cross-sectional area was noticed.
After MMA, all signs and symptoms of his OSA was
resolved and the patient was cured, and did not require
further CPAP.The maxilla was advanced 10mm and the
pogonion was advanced 18 mm (while including the
genioglossal advancement). The maxilla was expanded
by 14mm and the patient had his palatal splint removed
at 4months postoperatively. A counterclockwise rotation of 8 degrees was performed to increase the airway.
The minimal cross-sectional area increased from 29mm2
to 340mm2. (See . Figs.28.22, 28.23, and 28.24).
. Fig. 28.15 Panoramic radiograph
. Fig. 28.16 Minimum axial area improved from 88mm2 to 186mm
. Fig. 28.17 Signicant advancement was achieved at the ptery-
goid plates (11mm on the left side and 9mm on the right). A palatal
splint was digitally fabricated and used to achieve stability of the
transverse expansion
2
28
456
R. Movahed
. Fig. 28.18 Airway and volumetric improvement can be appreciated at all levels. MCA improved from 169mm2 to 308mm
. Fig. 28.19 Subapico osteotomy setback of the mandible was performed with rigid xation with genioglossal advancement, which facili-
tated more forward advancement than was otherwise possible
2
Maxillomandibular Advancement
457
28
. Fig. 28.20 Before and after lateral cepholemtric radiograph
28
458
R. Movahed
. Fig. 28.21 Pre- and 1-year postoperative photographs show signicantly improved facial harmony. The patient was cured of OSA
Maxillomandibular Advancement
459
28
. Fig. 28.22 Pre- and postoperative photographs
. Fig. 28.23 Pre- and postoperative lateral cephalometric radiographs
28
460
R. Movahed
. Fig. 28.24 Minimal cross-sectional area increased from 29mm2 to 340mm
28.8 Conclusion
CPAP has long been considered the gold standard
4. Young T, Peppard PE, Gottlieb DJ.Epidemiology of obstructive
5. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S.The
treatment for OSA and is often started rst-line in concert with noninvasive lifestyle modications, particularly for milder cases. The use of oral appliances has
also increased since they are also relatively easy to use
6. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla
and noninvasive. However, surgical intervention may
be the only effective way to treat OSA for many
patients. Short of tracheostomy, MMA has become a
7. Romero E, Krakow B, Haynes P, Ulibarri V.Nocturia and snor-
denitive, permanent treatment for OSA.MMA as a
denitive treatment for OSA is supported by an abundance of systematic reviews, meta-analyses, and cohort
8. Antic NA, Catcheside P, Buchan C, Hensley M, Naughton MT,
studies. However, more data are needed in the form of
prospective randomized controlled trials and other
research that can inform renements of current practices and innovations. Further modications of the
9. Appleton SL, Vakulin A, McEvoy RD, Vincent A, Martin SA,
MMA technique can optimize its employment, including streamlining of the virtual planning processes.
Education and outreach of referring providers, potential candidate patients, former patients, and improving
10. Stelmach-Mardas M, Mardas M, Iqbal K, Tower RJ, Boeing H,
general awareness in communities will help render it a
more acceptable and preferred treatment modality for
OSA.
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