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Which cephalometric analysis for maxillo-mandibular surgery in patients with obstructive sleep apnoea syndrome?

Maxillo-mandibular advancement MMA is considered an efficacious treatment for patients affected by severe obstructive sleep apnoea syndrome (OSAS). Even though OSAS improvement is the main goal of MMA, excessive maxillo-mandibular protrusion should be avoided to guarantee pleasant postoperative faci...

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Autores principales: BREVI, B., DI BLASIO, A., DI BLASIO, C., PIAZZA, F., D'ASCANIO, L., SESENNA, E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Pacini Editore SpA 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4720930/
https://www.ncbi.nlm.nih.gov/pubmed/26824915
http://dx.doi.org/10.14639/0392-100X-415
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author BREVI, B.
DI BLASIO, A.
DI BLASIO, C.
PIAZZA, F.
D'ASCANIO, L.
SESENNA, E.
author_facet BREVI, B.
DI BLASIO, A.
DI BLASIO, C.
PIAZZA, F.
D'ASCANIO, L.
SESENNA, E.
author_sort BREVI, B.
collection PubMed
description Maxillo-mandibular advancement MMA is considered an efficacious treatment for patients affected by severe obstructive sleep apnoea syndrome (OSAS). Even though OSAS improvement is the main goal of MMA, excessive maxillo-mandibular protrusion should be avoided to guarantee pleasant postoperative facial aesthetics. In order to attain such a result, the amount of MMA should be planned preoperatively by both aesthetic and cephalometric analyses. Steiner and Delaire cephalometric analyses are commonly used in the preoperative planning of orthognatic surgery for dentofacial deformities, however controversies still exist about the basis and postoperative aesthetic results of such cephalometric analyses in OSAS patients candidate for MMA. Forty-eight patients affected by severe OSAS were submitted to MMA. Pre- and post-operative Steiner and Delaire cephalometric tracings were assessed in each subject. For Steiner analysis, the variation in the SNA and SNB angles was measured, while for Delaire tracings the variation in the C3/FM-CPA and C3/FM-Me angles was assessed. Mean MMA was 6.9 + 3.8 mm for the maxilla and 13.6 + 5 mm for the mandible. After surgery, an improvement of the apnoea-hypopnoea index was recorded (40.47 + 7.64 preoperative vs. 12.56 + 5.78 postoperative). In all patients, both cephalometric analyses showed presurgical bimaxillary retrusion. After surgery, the mean value of Steiner's SNA angle increased from 78.18° to 85.58° (p < 0.001), while mean Delaire's C3/FM-CPA angle increased from 81.19° to 89.71° (p < 0.001). The mean value of Steiner's SNB angle increased from 74.33° to 80.73° (p < 0.001), while Delaire's C3/FM-Me angle increased from 80.10° to 87.29° (p < 0.001). Postoperatively, both the maxilla and mandible were in a more protrusive position (p < 0.001) according to Steiner analysis compared with Delaire tracing. Basing MMA on Delaire cephalometric analysis leads to an increased advancement of the maxillo-mandibular complex than Steiner tracing. The consequences of this aspect on facial aesthetics should be considered during surgical planning and preoperative informed consent in OSAS patients candidate for MMA.
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spelling pubmed-47209302016-01-29 Which cephalometric analysis for maxillo-mandibular surgery in patients with obstructive sleep apnoea syndrome? BREVI, B. DI BLASIO, A. DI BLASIO, C. PIAZZA, F. D'ASCANIO, L. SESENNA, E. Acta Otorhinolaryngol Ital Sleep Disorders Maxillo-mandibular advancement MMA is considered an efficacious treatment for patients affected by severe obstructive sleep apnoea syndrome (OSAS). Even though OSAS improvement is the main goal of MMA, excessive maxillo-mandibular protrusion should be avoided to guarantee pleasant postoperative facial aesthetics. In order to attain such a result, the amount of MMA should be planned preoperatively by both aesthetic and cephalometric analyses. Steiner and Delaire cephalometric analyses are commonly used in the preoperative planning of orthognatic surgery for dentofacial deformities, however controversies still exist about the basis and postoperative aesthetic results of such cephalometric analyses in OSAS patients candidate for MMA. Forty-eight patients affected by severe OSAS were submitted to MMA. Pre- and post-operative Steiner and Delaire cephalometric tracings were assessed in each subject. For Steiner analysis, the variation in the SNA and SNB angles was measured, while for Delaire tracings the variation in the C3/FM-CPA and C3/FM-Me angles was assessed. Mean MMA was 6.9 + 3.8 mm for the maxilla and 13.6 + 5 mm for the mandible. After surgery, an improvement of the apnoea-hypopnoea index was recorded (40.47 + 7.64 preoperative vs. 12.56 + 5.78 postoperative). In all patients, both cephalometric analyses showed presurgical bimaxillary retrusion. After surgery, the mean value of Steiner's SNA angle increased from 78.18° to 85.58° (p < 0.001), while mean Delaire's C3/FM-CPA angle increased from 81.19° to 89.71° (p < 0.001). The mean value of Steiner's SNB angle increased from 74.33° to 80.73° (p < 0.001), while Delaire's C3/FM-Me angle increased from 80.10° to 87.29° (p < 0.001). Postoperatively, both the maxilla and mandible were in a more protrusive position (p < 0.001) according to Steiner analysis compared with Delaire tracing. Basing MMA on Delaire cephalometric analysis leads to an increased advancement of the maxillo-mandibular complex than Steiner tracing. The consequences of this aspect on facial aesthetics should be considered during surgical planning and preoperative informed consent in OSAS patients candidate for MMA. Pacini Editore SpA 2015-10 /pmc/articles/PMC4720930/ /pubmed/26824915 http://dx.doi.org/10.14639/0392-100X-415 Text en © Copyright by Società Italiana di Otorinolaringologia e Chirurgia Cervico-Facciale http://creativecommons.org/licenses/by-nc-nd/3.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License, which permits for noncommercial use, distribution, and reproduction in any digital medium, provided the original work is properly cited and is not altered in any way. For details, please refer to http://creativecommons.org/licenses/by-nc-nd/3.0/
spellingShingle Sleep Disorders
BREVI, B.
DI BLASIO, A.
DI BLASIO, C.
PIAZZA, F.
D'ASCANIO, L.
SESENNA, E.
Which cephalometric analysis for maxillo-mandibular surgery in patients with obstructive sleep apnoea syndrome?
title Which cephalometric analysis for maxillo-mandibular surgery in patients with obstructive sleep apnoea syndrome?
title_full Which cephalometric analysis for maxillo-mandibular surgery in patients with obstructive sleep apnoea syndrome?
title_fullStr Which cephalometric analysis for maxillo-mandibular surgery in patients with obstructive sleep apnoea syndrome?
title_full_unstemmed Which cephalometric analysis for maxillo-mandibular surgery in patients with obstructive sleep apnoea syndrome?
title_short Which cephalometric analysis for maxillo-mandibular surgery in patients with obstructive sleep apnoea syndrome?
title_sort which cephalometric analysis for maxillo-mandibular surgery in patients with obstructive sleep apnoea syndrome?
topic Sleep Disorders
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4720930/
https://www.ncbi.nlm.nih.gov/pubmed/26824915
http://dx.doi.org/10.14639/0392-100X-415
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