Morbidity and Mortality Rates After Maxillomandibular Advancement for Treatment of Obstructive Sleep Apnea

LETTER TO THE EDITOR J Oral Maxillofac Surg -:1, 2016

MORBIDITY AND MORTALITY RATES AFTER MAXILLOMANDIBULAR ADVANCEMENT FOR TREATMENT OF OBSTRUCTIVE SLEEP APNEA

calculated that the absolute risk of a complication was 3.9 for the OSA group and 1.3 for the DFD group and that the relative risk of complications in the OSA group compared with the DFD group was 3.0. Because the number of patients in the OSA and DFD groups was relatively small (28 and 26 patients, respectively), even a shift of a small number of patients with undiagnosed OSA from the DFD group to the OSA group could directly affect the statistical results. In conclusion, craniofacial and dentofacial deformities can coexist with OSA, and only PSG can objectively show the presence of OSA preoperatively.5

To the Editor:—We recently read the article by Passeri et al1 in the Journal. They compared the morbidity and mortality rates of patients with obstructive sleep apnea (OSA) with those of patients with dentofacial deformity (DFD) who had undergone maxillomandibular advancement or similar maxillofacial surgical procedures. The topic of the study is important and interesting, not only for maxillofacial surgeons, but also for ear, nose, and throat surgeons, especially those working in the sleep medicine field. They concluded that the patients in the OSA group had more comorbidities and experienced a greater number of complications than those in the DFD group. We appreciate the authors for their valuable work; however, we think the method section of their article needs more clarification to prevent any misunderstandings. Polysomnography (PSG) is still the reference standard diagnostic method for OSA. Thus, performing PSG is mandatory to exclude the condition of OSA. The authors stated that, as one of the inclusion criteria, all the patients in the OSA group had undergone preoperative PSG. They also indicated that the patients undergoing orthognathic surgery for treatment of DFD were excluded if these patients had a diagnosis of OSA. However, the patients in the DFD group did not undergo PSG to determine the presence of OSA. In addition, the pathologic and clinical properties of the patients were not described clearly. It is well known that patients with dentofacial problems can have an atypical upper airway structure; hence, DFD and OSA can be present in the same patient.2,3 A recent meta-analysis revealed strong evidence for a reduced pharyngeal airway space and increased anterior facial height in adult patients with OSA compared with control subjects.4 Therefore, some of the patients in the DFD group might have had undiagnosed OSA. Passeri et al1

MURAT BINAR, MD OMER KARAKOC, MD Ankara, Turkey

References 1. Passeri LA, Choi JG, Kaban LB, Lahey ET III: Morbidity and mortality rates after maxillomandibular advancement for treatment of obstructive sleep apnea. J Oral Maxillofac Surg, 2016 2. Lowe AA, Ono T, Ferguson KA, et al: Cephalometric comparisons of craniofacial and upper airway structure by skeletal subtype and gender in patients with obstructive sleep apnea. Am J Orthod Dentofacial Orthop 110:653, 1996 3. Kurt G, Sisman C, Akin E, Akcam T: Cephalometric comparison of pharyngeal airway in snoring and non-snoring patients. Eur J Dent 5:84, 2011 4. Neelapu BC, Kharbanda OP, Sardana HK, et al: Craniofacial and upper airway morphology in adult obstructive sleep apnea patients: A systematic review and meta-analysis of cephalometric studies. Sleep Med Rev, 2016 5. Kim KB: How has our interest in the airway changed over 100 years? Am J Orthod Dentofacial Orthop 148:740, 2015

http://dx.doi.org/10.1016/j.joms.2016.05.030

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