(1314) Maxillomandibular Advancement Safety and Efficacy in OSA Management: Systematic Review and Meta Analysis

Introduction: Maxillomandibular Advancement (MMA) is an established surgical option for patients diagnosed with obstructive sleep apnea (OSA). The objective was to evaluate the complications and clinical efficacy of MMA in OSA management.

Methods: A comprehensive literature search of scientific databases (CINAHL, PubMed, SCOPUS, and Google Scholar) were searched from inception to May 2023. The search identified 380 English-language articles and 31 studies were included identifying patients with OSA who had undergone MMA with any complications included in further extraction. Meta-analysis of proportions, regressions, and single means with 95% confidence interval were calculated using random and fixed effects models.

Results: A total of 31 studies (n = 1,597) with MMA surgical patients showed significant improvements in AHI, RDI, SpO2 Nadir, ESS, and BMI by -41.87/h [ -49.86 to -33.89], -46.24/h [-62.18 to -30.29], 6.29% [3.42 to 12.08], -8.69 [-11.54 to -5.83], and -0.74kg/m2 [-1.35 to -0.12], respectively. The overall complication rate was found to be 51.04% [18.113 to 83.459]. Complications with the greatest incidence were found to be early and late lower facial numbness (83.4%, 40.44%), VPI (28.34%), malocclusion (24.81%), and hardware removal (21.99%). There was a positive correlation between both preoperative BMI and length of hospital stay (r = 0.81, p = 0.052) and age and lower facial numbness (r = 0.42, p = 0.196). A negative correlation was found between Change in AHI and Time to Follow Up (r = 0.75, p = 0.087). No association was found between change in AHI and mean preoperative BMI or worsening of facial appearance and change in AHI. No mortality was reported in any study.

Conclusions: We conclude that MMA is an effective treatment option for OSA. The most common complications associated with this procedure, such as lower facial numbness and others, should be highlighted preoperatively to ensure informed decisions are made. In future research, we aim to evaluate additional risk factors associated with these complications, aiding sleep surgeons in meeting patient’s expectations.