How does mandibular advancement with or without maxillary procedures affect pharyngeal airways? An overview of systematic reviews

PLoS One. 2017 Jul 27;12(7):e0181146. doi: 10.1371/journal.pone.0181146. eCollection 2017.

Abstract

Background: Mandibular advancement surgery may positively affect pharyngeal airways and therefore potentially beneficial to obstructive sleep apnea (OSA).

Objective: To collect evidence from published systematic reviews that have evaluated pharyngeal airway changes related to mandibular advancement with or without maxillary procedures.

Methodology: PubMed, EMBASE, Web of Science, and Cochrane Library were searched without limiting language or timeline. Eligible systematic reviews evaluating changes in pharyngeal airway dimensions and respiratory parameters after mandibular advancement with or without maxillary surgery were identified and included.

Results: This overview has included eleven systematic reviews. Maxillomandibular advancement (MMA) increases linear, cross-sectional plane and volumetric measurements of pharyngeal airways significantly (p<0.0001), while reducing the apnea-hypopnea index (AHI) and the respiratory disturbance index (RDI) significantly (p<0.0001). Two systematic reviews included primary studies that have evaluated single-jaw mandibular advancement, but did not discuss their effect onto pharyngeal airways. Based on the included primary studies of those systematic reviews, single-jaw mandibular advancement was reported to significantly increase pharyngeal airway dimensions (p<0.05); however, conclusive long-term results were lacking.

Conclusion: MMA increases pharyngeal airway dimensions and is beneficial to patients suffering from OSA. However, more evidence is still needed to draw definite conclusion related to the effect of single-jaw mandibular advancement osteotomies on pharyngeal airways.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Databases as Topic
  • Humans
  • Mandibular Advancement / methods*
  • Maxilla / surgery*
  • Osteotomy
  • Outcome Assessment, Health Care
  • Pharynx / surgery*

Grants and funding

This review was supported by General Research Fund through the Research Grants Council of Hong Kong SAR (project number: HKU 17121915). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of manuscript. The first author is partly funded by this grant to support her PhD study.