Mandibular distraction osteogenesis versus sagittal split ramus osteotomy in managing obstructive sleep apnea: A randomized clinical trial

Abstract

Purpose: To compare mandibular distraction osteogenesis (MDO) to sagittal split ramus osteotomy (SSRO) to treat moderate-to-severe obstructive sleep apnea (OSA), and their surgical morbidities and skeletal stability.

Materials and methods: A randomized clinical trial was conducted on non-syndromic adult patients with apnea-hypopnea index (AHI) 15 or above to receive MDO or SSRO as part or whole skeletal advancement surgery. Post-operative 1 year OSA cure rate (AHI < 5/hour) and treatment success rate (50% reduction of AHI and AHI< 20/hour) were compared. Polysomnography were conducted pre-operatively and post-operatively up to 2 years. Surgical morbidities and skeletal stability were analyzed.

Results: Eighteen patients (9 in each group) were recruited. Patient recruitment was terminated after two major complications in the MDO group. The OSA cure rate and treatment success rate showed no statistical difference between MDO group or SSRO group at post-operative 1 year. Major complication rate was 44.4% in the MDO group and 0 in the SSRO group. No statistical difference was found in skeletal stability between the two groups.

Conclusion: Both MDO and SSRO were highly effective to treat moderate-to-severe OSA. MDO had a high major complication rate and was not superior than SSRO in airway function improvement and skeletal stability.

Keywords: Mandibular distraction osteogenesis; Obstructive sleep apnea; Randomized clinical trial; Sagittal split ramus osteotomy.