Citation Information :
Agarwal S, Sahoo NK, Datana S, Bhandari SK. Efficacy of Distraction Osteogenesis in Management of Obstructive Sleep Apnea Secondary to Temporomandibular Joint Ankylosis. Indian Sleep Med 2021; 16 (2):44-48.
Aim and objective: The aim and objective of this study was to evaluate the efficacy of mandibular corpus distraction osteogenesis (MCDO) in the management of obstructive sleep apnea (OSA) secondary to temporomandibular joint (TMJ) ankylosis.
Materials and methods: Treatment records of 15 patients (mean age 23.3 ± 5.4 years, 7 males and 8 females) comprehensively managed for severe OSA secondary to TMJ ankylosis with combined orthodontics and MCDO were studied objectively by comparing apnea–hypopnea index (AHI) scores and airway parameters, and subjectively by Epworth sleepiness scale (ESS) survey at pretreatment (T0) and 1-year postsurgery (T1). Change in skeletal parameters at T1 was evaluated by comparison of sella-nasion-point A (SNA), sella-nasion-point B (SNB), and point A-nasion-point B (ANB) angles. Change in AHI per millimeter advancement was also calculated.
Results: The mean AHI score at T0 and T1 was 41.71 ± 12.69 and 8.11 ± 3.25, respectively (80.39% reduction, p-value < 0.001). The AHI reduction per mm distraction was 2.59 ± 0.52. The success rate (postsurgical AHI less than 50% of pretreatment) was 100%, and the cure rate (AHI score <05) was 80%. The mean ESS score at T0 and T1 was 18.60 ± 2.5 and 4.67 ± 1.49, respectively (75.05% reduction, p-value < 0.001). The mean ANB at T0 and T1 was 11.6° ± 3.68° and 3.4° ± 2.29, respectively (72.89% reduction, p-value < 0.001). The mean posterior airway space (PAS) at T0 and T1 was 4.00 ± 1.46 mm and 10.00 ± 1.25 mm, respectively (182.44% increase, p-value < 0.001).
Conclusions: MCDO is an effective modality for the treatment of severe OSA secondary to TMJ ankylosis. Further studies are recommended for additional evidence in this regard.
Holty JE, Guilleminault C. Maxillomandibular advancement for the treatment of obstructive sleep apnea: a systematic review and metaanalysis. Sleep Med Rev 2010;14:287–297. DOI: 10.1016/j.smrv.2009.11.003.
WZaghi S, Holty JE, Certal V, et al. Maxillomandibular advancement for treatment of obstructive sleep apnea. JAMA Otolaryngol Head Neck Surg 2016;142:58–66. DOI: 10.1001/jamaoto.2015.2678.
Li KK, Powell NB, Riley RW, et al. Long-term results of maxillomandibular advancement surgery. Sleep Breath 2000;4:137–139. DOI: 10.1007/s11325-000-0137-3.
Randerath WJ, Verbraecken J, Andreas S, et al. Non-CPAP therapies in obstructive sleep apnoea. Eur Respir J 2011;37:1000–1028. DOI: 10.1183/09031936.00099710.
Schendel SA, Epker BN. Results after mandibular advancement surgery: an analysis of 87 cases. J Oral Surg 1980;38:265–282. PMID: 6928455.
Van Sickels JE, Dolce C, Keeling S, et al. Technical factors accounting for stability of bilateral sagittal split osteotomy advancement: wire osteosynthesis versus rigid fixation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;89:19–23. DOI: 10.1016/s1079-2104(00)80008- 6.
Kim Y. Complications associated with orthognathic surgery. J Korean Assoc Oral Maxillofac Surg 2017;43:3. DOI: 10.5125/jkaoms.2017.43.1.3.
Heggie AA, Kumar R, Shand JM. The role of distraction osteogenesis in the management of craniofacial syndromes. Ann Maxillofac Surg 2013;3:4–10. DOI: 10.4103/2231-0746.110063.
Tsui WK, Yang Y, Cheung LK, Leung YY. Distraction osteogenesis as a treatment of obstructive sleep apnea syndrome: A systematic review. Medicine (Baltimore). 2016. DOI: 10.1097/MD.0000000000004674.
McCarthy JG, Schreiber J, Karp N, et al. Lengthening the human mandible by gradual distraction. Plast Reconstr Surg 1992;89:1–8. PMID: 1727238.
Adolphs N, Ernst N, Menneking H, et al. Significance of distraction osteogenesis of the craniomaxillofacial skeleton - a clinical review after 10 years of experience with the technique. J Craniomaxillofac Surg 2014;42:966–975. DOI: 10.1016/j.jcms.2014.01.018.
Gaur A, Singh G, Mishra M, et al. Distraction osteogenesis for management of obstructive sleep apnea secondary to TMJ ankylosis. Natl J Maxillofac Surg 2013;4:104–106. DOI: 10.4103/0975-5950.117820.
Roychoudhury A, Parkash H, Trikha A. Functional restoration by gap arthroplasty in temporomandibular joint ankylosis: a report of 50 cases. Oral Surg Oral Med Oral Pathol 1999;87:166–169. DOI: 10.1016/s1079-2104(99)70267-2.
Movahed R, Mercuri LG. Management of temporomandibular joint ankylosis. Oral Maxillofac Surg Clin N Am 2015;27:27–35. DOI: 10.1016/j.coms.2014.09.003.
Elshaug AG, Moss JR, Southcott AM, et al. Redefining success in airway surgery for obstructive sleep apnea: a meta analysis and synthesis of the evidence. Sleep 2007;30:461–467. DOI: 10.1093/sleep/30.4.461.
Mogell K, Blumenstock N, Mason E, et al. Definition of an effective oral appliance for the treatment of obstructive sleep apnea and snoring: an update for 2019. J Dent Sleep Med 2019;6:1–4. DOI: 10.15331/jdsm.7090.
Yadav R, Bhutia O, Shukla G, et al. Distraction osteogenesis for management of obstructive sleep apnoea in temporomandibular joint ankylosis patients before the release of joint. J Craniomaxillofac Surg 2014;42:588–594. DOI: 10.1016/j.jcms.2013.07.031.
Wang X, Wang XX, Liang C, et al. Distraction osteogenesis in correction of micrognathia accompanying obstructive sleep apnea syndrome. Plast Reconstr Surg 2003;112:1549–1557. DOI: 10.1097/01.PRS.0000086734.74795.C4.
Agarwal SS, Jayan B, Sahoo NK, et al. Mandibular corpus ditraction osteogenesis for the management of severe obstructive sleep apnea secondary to bilateral temporamandibular joint ankylosis. A case report. Indian J Sleep Med 2017;12(1):12–18. DOI: 10.5958/0974-0155.2017.00003.1.
Mohamed AM, Bishri AA, Mohamed AH. Distraction osteogenesis as followed by CT scan in Pierre Robin sequence. J Craniomaxillofac Surg 2011;39:412–419. DOI: 10.1016/j.jcms.2010.10.016.
Malkoc S, Usumez S, Nur M, et al. Reproducibility of airway dimensions and tongue and hyoid positions on lateral cephalograms. Am J Orthod Dentofacial Orthop 2005;128:513–516. DOI: 10.1016/j.ajodo.2005.05.001.
Looby JF, Schendel SA, Lorenz HP, et al. Airway analysis: with bilateral distraction of the infant mandible. J Craniofac Surg 2009;20:1341–1346. DOI: 10.1097/scs.0b013e3181ae4139.
Rachmiel A, Emodi O, Aizenbud D. Management of obstructive sleep apnea in pediatric craniofacial anomalies. Ann Maxillofac Surg 2012;2:111–115. DOI: 10.4103/2231-0746.101329.