DOI:

10.37988/1811-153X_2020_3_119

Orthognathic surgery planning in the complex treatment of the patients with obstructive sleep apnea. Part II

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Authors

  • M.A. Mokhirev 1, PhD in Medical Sciences, oral surgeon, research officer
  • D.A. Volchek 2, PhD in Medical Sciences, orthodontist, associate professor of the Dentistry department at the Institute of professional education
  • G.B. Ospanova 3, PhD in Medical Sciences, research adviser at the Orthodontics Division
  • A.U. Melnikov 1, somnologist and research officer
  • G.R. Arutunov 4, maxillofacial surgeon, research assistant
  • E.V. Pesenko 3, resident at the Orthodontics Division
  • 1 National Medical Research Center for Otorhinolaryngology, 123182, Moscow, Russia
  • 2 Sechenov University, 119435, Moscow, Russia
  • 3 Central Research Institute of Dental and Maxillofacial Surgery, 119021, Moscow, Russia
  • 4 Petrovsky National Research Centre of Surgery, 119991, Moscow, Russia

Abstract

MMA is the most effective surgical technique in the treatment of obstructive sleep apnea (OSA) for adult patients and gives way only tracheostomy treatment. However, despite the advantages, MMA is currently not widely used in the treatment of this pathology in the Russian Federation due to complexity, invasiveness and duration. The success of complex surgical treatment directly depends on the team approach and qualified specialists. The purpose of this publication is to popularize MMA among medical specialists involved in the treatment of OSA. Materials and methods. The authors evaluated the dynamics of the clinical and laboratory data (polysomnography, cone-beam computed tomography, articulated dental cast analysis) in patient with OSA and MMA treatment before and after 3 years post complex rehabilitation. Results. The results of the complex treatment: elimination of OSA, reduction in the snoring intensity, normalization of sleep quality, level of mean oxygen saturation, the position of the jaws and aesthetic proportions of the face, increase respiratory volume and lumen in the pharynx, establishing occlusion according to Angle class I, lack of dysfunction and pathological remodeling of the TMJ. Conclusion. The planning of the MMA with the use of cephalometric analysis considering changes in the soft tissues improved a lot the aesthetic proportions of the patient’s face. After long and complex treatment during 36 months, the elimination of the upper airway obstruction zones was achieved while maintaining and / or improving the normal function of the structures of the middle and lower zones of the face associated with them.

Key words:

orthognathic surgery, obstructive sleep apnea, snoring, orthodontic preparation, skeletal malocclusion

For Citation

[1]
Mokhirev M.A., Volchek D.A., Ospanova G.B., Melnikov A.U., Arutunov G.R., Pesenko E.V. Orthognathic surgery planning in the complex treatment of the patients with obstructive sleep apnea. Part II. Clinical Dentistry (Russia).  2020; 3 (95): 119—127. DOI: 10.37988/1811-153X_2020_3_119

References

  1. Epstein L.J., Kristo D., Jr P.J.S., Friedman N., Malhotra A., Patil S.P., Ramar K., Rogers R., Schwab R.J., Weaver E.M., Weinstein M.D., Medicine A.O.S.A.T.F.A.A.S. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. — J Clin Sleep Med. — 2009; 5 (3): 263—76. PMID: 19960649
  2. Nabiev F.K., Dobrodeev A.S., Libin P.V., Kotov I.I. Diagnostics and treatment of patients with II class malocclusion associated with obstructive sleep apnea syndrome. — Stomatologia. — 2014; 6: 74—7 (In Russ).
  3. Senyuk A.N., Volchek D.A., Bogatyrkov D.V., Mokhirev M.A. Peculiarities of orthodontic preparation before orthognatic operations in patients with skeletal anomaly of occlusion of 2nd Angle class. — Stomatologia. — 2010; 3: 65—68 (In Russ).
  4. Bezrukov V.M., Rabukhina N.A. Deformation of the facial skull. — Moscow: MIA, 205. — P. 272—293 (In Russ.).
  5. Mokhirev M.A., Volchek D.A., Tardov M.V., Ospanova G.B., Arutunov G.R., Vydrina A.E. Orthognatic surgery planning in complex treating obstructive sleep apnea. Part 1. — Clinical dentistry (Russia). — 2019; 1(89): 4—45 (In Russ).
  6. Gunson M.J., Arnett G.W. Orthognathic virtual treatment planning for functional esthetic results. — Seminars in Orthodontics. — 2019; 25:230—47. DOI: 10.1053/j.sodo.2019.08.008
  7. Rubio-Bueno P., Landete P., Ardanza B., Vázquez L., Soriano J.B., Wix R., Capote A., Zamora E., Ancochea J., Naval-Gías L. Maxillomandibular advancement as the initial treatment of obstructive sleep apnoea: Is the mandibular occlusal plane the key?. — Int J Oral Maxillofac Surg. — 2017; 46 (11): 1363—1371. PMID: 28760319
  8. Senyuk A.N., Ospanova G.B., Mokhirev M.A., Bogatyrkov D.V., Zhuk A.O., Volchek D.A., Askerov R.N., Nazaryan D.N. Stability evaluation of results of surgical jaw thrust with change in angulation of occlusal plane with comprehensive surgical orthodontics treatment of patients with dysgnathia, Class II. — Clinical dentistry (Russia). — 2012; 1 (61): 40—2 (In Russ).
  9. Kapur V.K., Auckley D.H., Chowdhuri S., Kuhlmann D.C., Mehra R., Ramar K., Harrod C.G. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. — J Clin Sleep Med. — 2017; 13 (3): 479—504. PMID: 28162150
  10. Kim J., Lagravére M.O. Accuracy of Bolton analysis measured in laser scanned digital models compared with plaster models (gold standard) and cone-beam computer tomography images. — Korean J Orthod. — 2016; 46 (1): 13—9. PMID: 26877978
  11. Joondeph D.R., Riedel R.A., Moore A.W. Pont’s index: a clinical evaluation. — Angle Orthod. — 1970; 40 (2): 112—8. PMID: 5266011
  12. Bushan M.G. Pathological teeth worn and its complications. — Kishenev: Shtiinca, 1979. — P. 94—95 (In Russ).
  13. Fadeev R.A., Zotova N.U., Kuzakova A.V. Method the survey of temporomandibular joint with dental computed tomography. — The Dental Institute. — 2011; 4 (53): 34—6 (In Russ).
  14. da Silva R.J., Souza C.V.V., Souza G.A., Ambrosano G.M.B., Freitas D.Q., Sant’Ana E., de Oliveira-Santos C. Changes in condylar volume and joint spaces after orthognathic surgery. — Int J Oral Maxillofac Surg. — 2018; 47 (4): 511—7. PMID: 29103834
  15. Abramson Z., Susarla S.M., Lawler M., Bouchard C., Troulis M., Kaban L.B. Three-dimensional computed tomographic airway analysis of patients with obstructive sleep apnea treated by maxillomandibular advancement. — J Oral Maxillofac Surg. — 2011; 69 (3): 677—86. PMID: 21353929
  16. Zaghi S., Holty J.-E.C., Certal V., Abdullatif J., Guilleminault C., Powell N.B., Riley R.W., Camacho M. Maxillomandibular advancement for treatment of obstructive sleep apnea: A meta-analysis. — JAMA Otolaryngol Head Neck Surg. — 2016; 142 (1): 58—66. PMID: 26606321
  17. Vigneron A., Tamisier R., Orset E., Pepin J.-L., Bettega G. Maxillomandibular advancement for obstructive sleep apnea syndrome treatment: Long-term results. — J Craniomaxillofac Surg. — 2017; 45 (2): 183—191. PMID: 28062177
  18. Susarla S.M., Abramson Z.R., Dodson T.B., Kaban L.B. Upper airway length decreases after maxillomandibular advancement in patients with obstructive sleep apnea. — J Oral Maxillofac Surg. — 2011; 69 (11): 2872—8. PMID: 21507540
  19. Arnett G.W., Gunson M.J. Management of condylar resorption before, during, and after orthognathic surgery. — International Journal of Oral & Maxillofacial Surgery. — 2011; 40 (10): 1021. DOI: 10.1016/j.ijom.2011.07.899
  20. Arnett G.W., Gunson M.J. Risk factors in the initiation of condylar resorption. — Seminars in Orthodontics. — 2013; 19 (2): 81—8. DOI: 10.1053/j.sodo.2012.11.001
  21. Cordray F.E. Articulated dental cast analysis of asymptomatic and symptomatic populations. — Int J Oral Sci. — 2016; 8 (2): 126—32. PMID: 27357324

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Published on

September 15, 2020