J Oral Maxillofac Surg 2006 Jun; 64(6): 886-91 (Read article online)

Hoekema A, de Lange J, Stegenga B, de Bont LG

PURPOSE: The present study comprises a retrospective evaluation of the potential application of mandibular repositioning appliance (MRA) therapy preceding maxillomandibular advancement (MMA) surgery in the treatment of the Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS). Our initial experiences with a new surgical protocol, in which MRA therapy serves as a predictor for success of MMA surgery, are reported. PATIENTS AND METHODS: Forty-three consecutive patients with OSAHS treated with MRA therapy were considered for inclusion (mean +/- SD; Apnea-Hypopnea Index [AHI] = 27 +/- 20; age = 53 +/- 9 years). All patients displaying a substantial improvement in their AHI with MRA therapy (ie, >50% reduction) who preferred surgical rather than "prosthetic" advancement of the mandible were offered MMA surgery. Accordingly, 4 out of 43 patients were treated with MMA surgery. The AHI was used as the primary outcome measure, with MMA surgery being considered successful in case of a postoperative AHI <5. RESULTS: All 4 patients included displayed substantial improvement in their AHI following MRA therapy. Moreover, in 3 patients MRA therapy resulted in a post-treatment AHI