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Francisco I, Travassos R, Baptista Paula A, Oliveiros B, Marques F, Prata Ribeiro M, McEvoy M, Santos M, Oliveira C, Marto CM, Carrilho E, Nunes C, Vale F. Evaluation of quality of life after orthognathic surgery in obstructive sleep apnea syndrome: a systematic review. Angle Orthod 2025; 95:104-125. [PMID: 39509465 DOI: 10.2319/020624-99.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 09/05/2024] [Indexed: 11/15/2024] Open
Abstract
OBJECTIVES To develop a systematic review of patient perspectives on the treatment of obstructive sleep apnea syndrome (OSAS) after undergoing orthognathic advancement surgery. MATERIALS AND METHODS This systematic review adhered to the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines, and Patient, Intervention, Comparison, and Outcome (PICO) methodology was employed to formulate the research question. A literature search was performed using the following databases: Cochrane Library (Trials), PubMed via MEDLINE, Embase, and Web of Science (all databases). The Newcastle-Ottawa Scale was used to assess quality of the studies. RESULTS Initially, 1407 articles were retrieved from diverse databases, and these were subjected to initial scrutiny. Subsequently, 17 articles were selected for thorough quality analysis and 6 studies for quantitative analysis. Most studies were classified as good quality. Maxillomandibular advancement surgery appeared to enhance patient satisfaction in cases of moderate to severe adult OSAS. CONCLUSIONS Maxillomandibular advancement surgery significantly improves patients' subjective overall quality of life, improving by 6.36 points in questionnaire ratings and demonstrating long-term stability.
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Francisco I, Nunes C, Baptista Paula A, Marques F, Prata Ribeiro M, McEvoy M, Santos M, Oliveira C, Marto CM, Spagnuolo G, Carrilho E, Travassos R, Vale F. Patient-Reported Outcomes of Maxillomandibular Surgery for Obstructive Sleep Apnea Treatment: A Scoping Review. J Clin Med 2024; 13:1232. [PMID: 38592097 PMCID: PMC10932142 DOI: 10.3390/jcm13051232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/12/2024] [Accepted: 02/18/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: The present scoping review aims to scrutinize all existing patient-reported outcomes and assess the perspectives of obstructive sleep apnea patients after maxillomandibular surgery. (2) Methods: The review was carried out according to the extensions for scoping reviews using the PRISMA-ScR guidelines. Several databases were used to carry out the initial search. This study included randomized controlled trials, cohort studies, cross-sectional and case-control studies. The included studies considered patients with obstructive sleep apnea who were submitted to orthognathic surgery as the main subjects, and the patient's perception of quality of life, satisfaction, treatment experience and side effects were assessed. (3) Results: From 1407 examined articles, a total of 16 were included. Most of the included studies used more than one questionnaire to assess quality of life, except for five articles. The most commonly referred instruments were the Epworth Sleepiness Scale, SF-36, the Functional Outcomes of Sleep and Ottawa Sleep Apnea. The most commonly assessed outcomes were sleep quality, daytime function, facial aesthetics, dental function and emotional health. (4) Conclusions: The number of variables that can be evaluated from a patient's perspective are endless, as are the tools available to assess them. Not all of these tools, which are generally questionnaires, assess all the various outcomes, and some do not compare the pre- and post-surgical situations. Most of them are generic and lack specificity for obstructive sleep apnea.
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Affiliation(s)
- Inês Francisco
- Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.N.); (A.B.P.); (F.M.); (M.P.R.); (M.M.); (M.S.); (C.O.); (R.T.); (F.V.)
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.M.M.); (E.C.)
- Laboratory for Evidence-Based Sciences and Precision Dentistry, University of Coimbra, 3000-075 Coimbra, Portugal
- Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-075 Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), 3030-370 Coimbra, Portugal
| | - Catarina Nunes
- Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.N.); (A.B.P.); (F.M.); (M.P.R.); (M.M.); (M.S.); (C.O.); (R.T.); (F.V.)
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.M.M.); (E.C.)
- Laboratory for Evidence-Based Sciences and Precision Dentistry, University of Coimbra, 3000-075 Coimbra, Portugal
- Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-075 Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), 3030-370 Coimbra, Portugal
| | - Anabela Baptista Paula
- Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.N.); (A.B.P.); (F.M.); (M.P.R.); (M.M.); (M.S.); (C.O.); (R.T.); (F.V.)
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.M.M.); (E.C.)
- Laboratory for Evidence-Based Sciences and Precision Dentistry, University of Coimbra, 3000-075 Coimbra, Portugal
- Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-075 Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), 3030-370 Coimbra, Portugal
- Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal
| | - Filipa Marques
- Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.N.); (A.B.P.); (F.M.); (M.P.R.); (M.M.); (M.S.); (C.O.); (R.T.); (F.V.)
| | - Madalena Prata Ribeiro
- Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.N.); (A.B.P.); (F.M.); (M.P.R.); (M.M.); (M.S.); (C.O.); (R.T.); (F.V.)
| | - Mariana McEvoy
- Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.N.); (A.B.P.); (F.M.); (M.P.R.); (M.M.); (M.S.); (C.O.); (R.T.); (F.V.)
| | - Mariana Santos
- Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.N.); (A.B.P.); (F.M.); (M.P.R.); (M.M.); (M.S.); (C.O.); (R.T.); (F.V.)
| | - Catarina Oliveira
- Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.N.); (A.B.P.); (F.M.); (M.P.R.); (M.M.); (M.S.); (C.O.); (R.T.); (F.V.)
| | - Carlos Miguel Marto
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.M.M.); (E.C.)
- Laboratory for Evidence-Based Sciences and Precision Dentistry, University of Coimbra, 3000-075 Coimbra, Portugal
- Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-075 Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), 3030-370 Coimbra, Portugal
- Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal
- Institute of Experimental Pathology, Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal
| | - Gianrico Spagnuolo
- Department of Neurosciences, Reprodutive and Odontostomatological Sciences, University of Naples “Federico II”, 80138 Naples, Italy
| | - Eunice Carrilho
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.M.M.); (E.C.)
- Laboratory for Evidence-Based Sciences and Precision Dentistry, University of Coimbra, 3000-075 Coimbra, Portugal
- Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-075 Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), 3030-370 Coimbra, Portugal
- Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal
| | - Raquel Travassos
- Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.N.); (A.B.P.); (F.M.); (M.P.R.); (M.M.); (M.S.); (C.O.); (R.T.); (F.V.)
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.M.M.); (E.C.)
- Laboratory for Evidence-Based Sciences and Precision Dentistry, University of Coimbra, 3000-075 Coimbra, Portugal
- Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-075 Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), 3030-370 Coimbra, Portugal
| | - Francisco Vale
- Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.N.); (A.B.P.); (F.M.); (M.P.R.); (M.M.); (M.S.); (C.O.); (R.T.); (F.V.)
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.M.M.); (E.C.)
- Laboratory for Evidence-Based Sciences and Precision Dentistry, University of Coimbra, 3000-075 Coimbra, Portugal
- Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-075 Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), 3030-370 Coimbra, Portugal
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Esen A, Celik B, Dolanmaz D. Biomechanical evaluation of two miniplate fixations applied in the anterior region after Le Fort I osteotomy: an experimental study. Br J Oral Maxillofac Surg 2021; 60:152-156. [PMID: 34862066 DOI: 10.1016/j.bjoms.2021.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/30/2021] [Indexed: 10/22/2022]
Abstract
The aim of this experimental study was to evaluate the reliability of two-plate fixations applied to the anterior region of the maxilla after Le Fort I osteotomy in terms of stability. Twenty polyurethane-based skull models were used to evaluate two fixation techniques. Two groups consisting of four and two L-shaped titanium miniplates were tested. Each group was tested with the application of vertical forces in the anteroposterior direction using a servohydraulic testing unit. The displacement values in each group at each stage (from 10 N - 120 N) were compared using the Mann-Whitney U test. The displacement values for the two groups were not statistically significant up to 20 N, but differed significantly between 20 N and 120 N (p < 0.05). The results showed that the biomechanical behaviour of fixation with four miniplates was better than that of two after a load of 20 N. It can be concluded that when the amount of maxillary advancement is increased to 10 mm or more, fixation with only two plates does not provide sufficient stability experimentally.
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Affiliation(s)
- A Esen
- Necmettin Erbakan University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Beysehir Cd. Baglarbasi Sk., 42090 Meram, Konya, Turkey.
| | - B Celik
- Selcuk University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Alaeddin Keykubat Yerleskesi, 42250 Selcuklu, Konya, Turkey
| | - D Dolanmaz
- Bezmialem Vakif University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Adnan Menderes Bulvari, 34093, Fatih, Istanbul, Turkey
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Should Multilevel Phase I Surgical Therapy be Recommended as Treatment for Moderate Obstructive Sleep Apnea due to Oropharyngeal and Hypopharyngeal Obstruction? J Oral Maxillofac Surg 2020; 78:2282-2288. [PMID: 32898482 DOI: 10.1016/j.joms.2020.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 08/07/2020] [Accepted: 08/07/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the efficacy of multilevel phase I surgery for the treatment of moderate obstructive sleep apnea (OSA) in retrognathic patients with oropharyngeal and hypopharyngeal obstruction. MATERIALS AND METHODS This was a 10-year retrospective cohort study of patients treated by a single surgeon at the Boston University Medical Center. From 2000 to 2010, retrognathic patients with moderate OSA and verified palatal and tongue base obstruction were treated with multilevel phase I surgery that included uvulopalatopharyngoplasty, hyoid suspension, and genioglossus advancement. All patients were evaluated clinically and received polysomnographic studies at three time points: preoperatively (T1), between 6 and 12 months postoperatively (T2), and a minimum of 24 months postoperatively (T3). RESULTS Twenty-five subjects composed the final study sample. At T2, 11 patients (44.0%) experienced a complete response, 13 (52.0%) experienced a partial response, and 1 (4.0%) experienced no response. Although phase I surgery was associated with significant changes in AHI (F(2,48) = 119.3; P < .01) throughout the follow-up period, only one patient at T3 (4.0%) met the criteria for a complete response. The remaining patients were divided evenly between partial response (48.0%) and treatment failure (48.0%), of whom 4 (16.0%) patients had worsening of their obstruction. Thirteen of these patients subsequently elected to undergo maxillomandibular advancement, while 11 elected to continue using continuous positive airway pressure. CONCLUSIONS Although phase I surgery was associated with AHI changes, this reduction was not sufficient to produce a long-term treatment response in over half of our patients. Treatment response was worse after 2 years than at 6 to 12 months. Patients with moderate OSA should understand that multilevel phase I surgery has a greater chance of failure than success and that transient improvements may not be durable.
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