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Volumetric analysis of the pharynx in patients with obstructive sleep apnea (OSA) treated with maxillomandibular advancement (MMA)

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Abstract

Introduction

Maxillomandibular advancement (MMA) has been reported to be the most effective surgical treatment of obstructive sleep apnea (OSA). Most reports about MMA aim to confirm the efficiency of this treatment modality, but few describe the anatomical changes produced in the pharynx by the surgery. Thus, the objective of the present investigation was to quantify the anatomical changes of the pharynx that occur in patients with OSA after MMA surgery using magnetic resonance (MR).

Methods

Twenty patients with a polysomnographic diagnosis of OSA participated in the study. All patients were submitted to image acquisition by MR performed during wakefulness. Polysomnography and MR were performed preoperatively and 6 months after MMA. Volume analysis (in cubic millimeters) was performed as the sum of the areas multiplied by their thickness, with no intervals between sections. The pharyngeal air space of the region between the hard palate and the base of the epiglottis was divided into a retropalatal (RP) region and a retrolingual (RL) region.

Results

Postoperative MR showed a mean volumetric increase of 26.72 % in the RP region and of 27.2 % in the RL region.

Discussion

MMA increases the air space of the pharynx by expanding the facial skeletal structure to which the soft tissues of the pharynx and tongue are fixed, with a consequent reduction of collapsibility in the presence of negative pressure during inspiration. This reduced possibility of pharyngeal collapse may contribute to the reduction of obstructive events.

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Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, University of São Paulo, Ribeirão Preto, SP, Brazil

    Ana Célia Faria, Savio Nogueira da Silva-Junior & Francisco Veríssimo de Mello-Filho

  2. Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, University of São Paulo, Ribeirão Preto, SP, Brazil

    Luis Vicente Garcia

  3. Center of Imaging Sciences and Medical Physics, University of São Paulo, Ribeirão Preto, SP, Brazil

    Antonio Carlos dos Santos

  4. Department of Neurology, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil

    Maria Regina França Fernandes

  5. Centro Integrado de Estudos das Deformidades da Face (CIEDEF), Campus, University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Av. Bandeirantes, 3900, 14049-900, Ribeirão Preto, SP, Brazil

    Ana Célia Faria

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  1. Ana Célia Faria
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  2. Savio Nogueira da Silva-Junior
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  3. Luis Vicente Garcia
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  5. Maria Regina França Fernandes
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  6. Francisco Veríssimo de Mello-Filho
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Correspondence to Ana Célia Faria.

Additional information

The research was carried out at the Integrated Center of Study of Facial Deformities (CIEDEF), University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Brazil. The research protocol was approved by the Research Ethics Committee of the University Hospital of Ribeirão Preto (HCRP) and of the Faculty of Medicine of Ribeirão Preto, Universidade de São Paulo (FMRP-USP), protocol no. HCRP 6245/2006.

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Faria, A.C., da Silva-Junior, S.N., Garcia, L.V. et al. Volumetric analysis of the pharynx in patients with obstructive sleep apnea (OSA) treated with maxillomandibular advancement (MMA). Sleep Breath 17, 395–401 (2013). https://doi.org/10.1007/s11325-012-0707-1

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  • DOI: https://doi.org/10.1007/s11325-012-0707-1

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