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Effects of transverse maxillomandibular distraction osteogenesis on obstructive sleep apnea syndrome and on the pharynx

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

To assess the effects of transverse maxillomandibular distraction osteogenesis (TMDO) on the treatment of obstructive sleep apnea (OSA) and on the morphology of the pharynx.

Methods

A clinical trial was conducted with seven patients with OSA and with transverse maxillomandibular deficiency, two women and five men aged on average 41.16 ± 10.9 years on the day of surgery. All participants were submitted to computed tomography (CT) and full-night polysomnography (PSG) before and approximately 9 months after surgery. A 95% confidence interval was defined.

Results

The AHI and RDI of the participants were reduced by about 62% (from 27.65 ± 36.65 to 10.73 ± 11.78, p = 0.031 and from 41.21 ± 32.73 to 15.30 ± 13.87, p = 0.015, respectively). The airway showed a surprising mean reduction in volume of 10% (from 5.78 ± 2.53 to 4.71 ± 1.42, p = 0.437, for the upper pharynx; from 6.98 ± 2.23 to 6.23 ± 2.05, p = 0.437, for the lower pharynx; and from 12.76 ± 1.56 to 10.94 ± 2.42, p = 0.625, for the total pharynx). However, the site of the smallest area of the pharynx was considerably increased both in the anteroposterior and transverse direction and in its total area (from 0.88 ± 7.11 to 0.99 ± 0.39, p = 0.625; from 1.78 ± 0.81 to 2.05 ± 0.61, p = 0.812; and from 0.99 ± 0.74 to 1.40 ± 0.51, p = 0.180, respectively).

Conclusion

TMDO proved to be efficient in reducing or curing OSA, producing modifications of upper pharynx morphology with an increase of the smallest area of the pharynx.

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Abbreviations

TMDO:

Transverse maxillomandibular distraction osteogenesis

SARME:

Transverse maxillary distraction osteogenesis or surgically assisted rapid

maxillary expansion

PNS:

Posterior nasal spine

UP:

Upper pharynx

LP:

Lower pharynx

TP:

Total pharynx

OSA:

Obstructive sleep apnea

CT:

Computed tomography

PSG:

Full-night polysomnography

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Funding

This study received financial support from FAPESP (Fundação de Amparo à Pesquisa do Estado de São Paulo), no. 2011.50305-7.

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Authors and Affiliations

  1. Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, SP, 14049-900, Brazil

    Pedro Pileggi Vinha, Ana Célia Faria, Mariana Christino & Francisco Veríssimo de Mello-Filho

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  1. Pedro Pileggi Vinha
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  2. Ana Célia Faria
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  3. Mariana Christino
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  4. Francisco Veríssimo de Mello-Filho
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Correspondence to Pedro Pileggi Vinha.

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The authors declare that they have no conflict of interest.

Ethics statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Highlights

TMDO is highly efficient for the treatment of OSA

TMDO is the second most efficient surgery for the treatment of OSA

Despite the improvement of OSA, there was a reduction in the volume of the pharynx

The reduction of airway volume was compensated for with an increase of the smallest area of the pharynx

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Vinha, P.P., Faria, A.C., Christino, M. et al. Effects of transverse maxillomandibular distraction osteogenesis on obstructive sleep apnea syndrome and on the pharynx. Sleep Breath 24, 875–884 (2020). https://doi.org/10.1007/s11325-019-01916-1

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