Reconstruction of the adult hemifacial microsomia patient with temporomandibular joint total joint prosthesis and orthognathic surgery

HFM patients' reconstruction has always been a challenge for maxillofacial surgeons, and numerous reconstructive techniques have been described. Surgical treatment depends on the patient's age and contemplates Temporomandibular Joint (TMJ) reconstruction in conjunction with orthognathic surgery, usually necessary following completion of growth to maximize the functional and esthetic results. Distraction osteogenesis had gained popularity as valid alternative in growing patients, but the two primary methods to reconstruct the TMJs involve the use of autogenous, using free or microvascular bone grafts, or alloplastic graft, but there is no widely accepted method

Maxillomandibular advancement:Issues related to indication, surgery, and outcome

Obstructive Sleep Apnea (OSA) is a common sleep-related breathing disorder that causes significant health problems. This condition is characterized by repeated episodes of partial or complete obstruction of the upper airway, leading to breathing disturbances and oxygen depletion. OSA affects sleep quality, cognitive function, and increases the risk of accidents. The prevalence of OSA is rising due to factors such as obesity and an aging population.The diagnosis of OSA is often made through polysomnography, and treatment ranges from lifestyle adjustments to continuous positive airway pressure (CPAP) therapy. Maxillomandibular advancement (MMA) osteotomy, a form of orthognathic surgery, which involves adjusting the upper and lower jaws to enlarge the airway, is an effective surgical option.This dissertation investigates various aspects of MMA for OSA. It assesses the clinical efficacy and safety of MMA in comparison to other surgical treatments. It identifies predictors of surgical success and evaluates the effectiveness of MMA in patients with different types of apnea. It also examines the suitability of MMA in patients with hypopnea-dominant OSA and the impact of MMA on the type of OSA.Furthermore, an orthognathic treatment protocol for edentulous patients is examined, focusing on the accuracy and predictability without intraoperative wafers. The effect of surgical experience on the outcomes of MMA is also explored, as well as the surgical accuracy of performed MMA.This thesis highlights MMA's role as an effective treatment option for OSA, with attention to patient selection, clinical efficiency, safety, and surgical accuracy. The results contribute to the understanding and development of MMA as a treatment for OSA

Major clinical results of orthognatic surgery in obstructive sleep apnea syndrome: a systematic review

Introduction: Obstructive sleep apnea involves obstruction or narrowing of an individual's airways during sleep and is associated with several comorbidities. Management can be surgical or non-surgical, and Phase II of the Stanford Protocol for surgical management involves maxillomandibular advancement. Objective: To conduct a concise systematic review to present the main considerations and clinical results of orthognathic surgery in obstructive sleep apnea syndrome. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from April to June 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 110 articles were found, 41 articles were evaluated and 23 were included in this systematic review. Considering the Cochrane tool for risk of bias, the global assessment resulted in 28 studies with a high risk of bias and 28 studies that did not meet GRADE. Most studies showed homogeneity in their results, with X2 =88.5% >50%. Maxillomandibular advancement surgery is a successful treatment for obstructive sleep apnea, but there are still concerns about cosmetic results due to the major advances involved. Bimaxillary advancement osteotomy significantly increases oropharyngeal volume and contracted superficial areas, which remain stable between 6 months and 1 year postoperatively

Interrelationship between implant and orthognathic surgery for the rehabilitation of edentulous cleft palate patients: a case report

A 43-year-old woman with a unilateral cleft lip and palate, presenting a totally edentulous maxilla and mandible with marked maxillomandibular discrepancy, attended the Prosthodontics section of the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo for treatment. She could not close her mouth and was dissatisfied with her complete dentures. Treatment planning comprised placement of six implants in the maxilla, four in the mandible followed by prostheses installation and orthognathic surgery. The mandibular full arch prosthesis guided the occlusion for orthognathic positioning of the maxilla. The maxillary complete prosthesis was designed to assist the orthognathic surgery with a provisional prosthesis (no metal framework), allowing reverse treatment planning. Maxillary and mandibular realignment was performed. Three months later, a relapse in the position of the maxilla was observed, which was offset with a new maxillary prosthesis. This isa complex interdisciplinary treatment and two-year follow-up is presented and discussed. It should be considered that this type of treatment could also be applied in non-cleft patients

Maxillary Advancement for Unilateral Crossbite in a Patient with Sleep Apnea Syndrome

This article reports the case of a 44-year-old male with skeletal Class III, Angle Class III malocclusion and unilateral crossbite with concerns about obstructive sleep apnea syndrome (OSAS), esthetics and functional problems. To correct the skeletal deformities, the maxilla was anteriorly repositioned by employing LeFort I osteotomy following pre-surgical orthodontic treatment, because a mandibular setback might induce disordered breathing and cause OSAS. After active treatment for 13 months, satisfactory occlusion was achieved and an acceptable facial and oral profile was obtained. In addition, the apnea hypopnea index (AHI) decreased from 18.8 preoperatively to 10.6 postoperatively. Furthermore, after a follow-up period of 7 months, the AHI again significantly decreased from 10.6 to 6.2. In conclusion, surgical advancement of the maxilla using LeFort I osteotomy has proven to be useful in patients with this kind of skeletal malocclusion, while preventing a worsening of the OSAS

Management of Obstructive Sleep Apnea by Maxillomandibular Advancement Surgery

Obstructive sleep apnea (OSA) is a common disorder characterized by recurrent episodes of partial or complete collapsibility of upper airway during sleep. The use of nocturnal positive airway pressure that pneumatically stents open the upper airway has been considered the first-line treatment of OSA. However, in the last two decades, maxillomandibular advancement (MMA) has been widely suggested as the most effective craniofacial surgical technique for the treatment of OSA in adults. It has been shown that the pharyngeal and hypopharyngeal airway could be enlarged with MMA surgery by physically expanding the facial skeletal framework. Tissue tension could be increased by forward movement of the maxillomandibular complex. Thus, collapsibility of the velopharyngeal and suprahyoid musculature could be decreased, and lateral pharyngeal wall collapse could be improved. Recent systematic reviews and meta-analyses showed that most of the subjects reported satisfaction after MMA with improvements in quality of life (QOL) measures and most of OSA symptomatology. According to the recent updates, MMA appears to be the most successful surgical option for the treatment of OSA, and it could be an excellent alternative procedure for nonresponders, or deniers of ventilation therapy

Maxillofacial surgery in patients with obstructive sleep apnea and snoring

The present survey systematizes the modern foreign literature devoted to the recent advances in the surgical management of the patients with obstructive sleep apnea and snoring. The results from the application of a variety of contemporaty methods are briefly described. A special attention is paid to the maxillomandibular advancement that represents the most common maxillofacial surgical technique in this interdisciplinary field. The promising perspectives of multi-level surgery of the upper airway for obstructive sleep apnea are mentioned, too

Interrelationship between implant and orthognathic surgery for the rehabilitation of edentulous cleft palate patients: a case report

A 43-year-old woman with a unilateral cleft lip and palate, presenting a totally edentulous maxilla and mandible with marked maxillomandibular discrepancy, attended the Prosthodontics section of the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo for treatment. She could not close her mouth and was dissatisfied with her complete dentures. Treatment planning comprised placement of six implants in the maxilla, four in the mandible followed by prostheses installation and orthognathic surgery. The mandibular full arch prosthesis guided the occlusion for orthognathic positioning of the maxilla. The maxillary complete prosthesis was designed to assist the orthognathic surgery with a provisional prosthesis (no metal framework), allowing reverse treatment planning. Maxillary and mandibular realignment was performed. Three months later, a relapse in the position of the maxilla was observed, which was offset with a new maxillary prosthesis. This isa complex interdisciplinary treatment and two-year follow-up is presented and discussed. It should be considered that this type of treatment could also be applied in non-cleft patients

Volumetric, planar and linear airway comparison after maxillomandibular advancement surgery

Background and Objectives: Treatment of sleep apnea can be accomplished using both non-surgical and surgical methods. Surgical treatment is further classified into phase I and II surgery. When phase I treatment fails, orthognathic surgery is judged to be the subsequent step in treating these patients. Orthognathic surgery is considered phase II treatment and can consist of a maxillomandibular advancement (MMA)1-11. Until recently, most of the data gathered on patients how have had a maxillomandibular advancement has been completed using lateral cephalograms. The rationale for this study is to gain a better understanding of the alteration in linear, planar and volumetric posterior airway space following double-jaw advancement surgery with a counter-clockwise rotation of the occlusal plane. Methods: A total of 28 subjects pre- and post-surgical CBCT scans were evaluated. All of the individuals underwent a maxillomandibular advancement with a counterclockwise rotation of the occlusal plane. All DICOM files were analyzed using Dolphin 3D Imaging 11.5, licensed to West Virginia University Department of Orthodontics. The CBCT volume was used to create right lateral cephalograms which were then used for linear cephalometric measurements. The 3D volume was also utilized to find cross-sectional measurements from axial slices taken from the cone-beam images at specific points: PNS, CV1, CV2 and CV3. Finally, CBCT images were used to find volume measurements at explicit regions along the posterior airway space. Data was analyzed using a matched-pair test. Results: When all subjects were grouped together the p-value for the change in all variables was \u3c0.05. This indicates that there was a statistically significant change in all variables regardless of the method used to evaluate pre- and post-surgery changes. It also suggests that although CBCT is a valuable tool to evaluate airway change, cephalometric radiographs can be used to determine whether change in PAS is significant when it pertains to maxillomandibular advancement surgery. Conclusions: The maxillomandibular advancement procedure with or without genioplasty illustrated great increases in posterior airway space in both 2-dimensional and 3-dimensional analyses. However, more information was available in regards to site of airway obstruction when utilizing the 3D data in comparison to 2D. Patients with obstructive sleep apnea should be presented with the option of MMA surgery as a treatment option if CPAP is not tolerated or other therapies have failed