Skeletal Advancement Surgery in Patients with Moderate-to-Severe Obstructive Sleep Apnea

Abstract

Purpose of Review: Skeletal advancement surgery is a surgical treatment of facial bone for patients with moderate-to-severe obstructive sleep apnea (OSA), i.e., of apnea-hypopnea index (AHI) > 15, by expanding the airway and tenting up the soft tissue. It has been shown effective in managing adult patients with OSA as well as neonatals. The purpose of the review was to provide an update on the evidence and considerations of skeletal advancement surgery.

Recent Findings: Skeletal advancement surgery addresses multilevel obstruction by expanding the skeletal framework and increases stability at the lateral pharyngeal wall, the velum, and the tongue base. Drug-induced sleep endoscopy provides valuable information of the patients’ obstruction region and pattern during sleep and helps in the surgical planning process. Skeletal advancement surgery demonstrates drastic reduction of parameters related to OSA. It also showed very high OSA success rate and cure rate in several systematic reviews and meta-analyses. A recent meta-analysis showed a pooled success and cure rates of 85.5% and 38.5%, respectively. Long-term studies showed the airway function outcomes were stable with low risks of major complications such as cardiac arrests, dysrhythmia, and mandibular fracture.

Summary: Skeletal advancement surgery is highly effective and safe in treating patients with moderate-to-severe OSA.