II trattamento chirurgico della sindrome delle apnee ostruttive del sonno (OSAS) grave mediante avanzamento maxillo-mandibolare

Background: This work analyzes and evaluates the role carried out by surgery in the treatment of severe obstructive sleep apnea syndrome (OSAS), particularly referring to the results obtained by maxillo-mandibular advancement. Aim: The Authors statistically analyse data from a surgical protocol consisting of maxillo-mandibular advancement as indication in the treatment of severe OSAS associated to cranio-facial abnormalities. Results from our clinical experience are compared with those from the international literature. Clinical indications of candidates to maxillo-mandibular advancement and the ability to face these cases are illustrated. Methods: Fifteen patients affected by OSAS were studied. Data from cardiorespiratory monitoring (Mesam IV), cephalometry, pre- and post-surgery clinical examinations were considered. Particular evaluations have been carried out concerning: oxygen desaturation index (ODI), lowest Sat. O₂ %, snoring time (%), posterior airway space (PAS), SNA and SNB angles on cephalometry, Epworth sleepiness scale, morning headache. Results: All patients showed an increase in width of PAS (doubled in 11 cases) and a complete remission of subjective OSAS symptoms. Events of desaturation significantly decreased in all patients (ODI from 48.1 to 7.8) as well as the percentage of snoring which almost disappeared in 6 patients (<10%). OSAS symptoms rapidly relieved in all patients, with discharge of nasal continuous positive airway pressure (nCPAP) after surgical operation. Conclusions: The primary goal of the surgical therapy of the OSAS must be the complete recovery from the syndrome, or at least a significant improvement of the clinical picture. Our results are similar and concordant with those from the literature. Therefore, we believe that, at present, maxillo-mandibular advancement is an effective and reliable surgical choice in the treatment of severe OSAS.