This is a meta-analysis compiled from India. Of the initial 103 publications 20 were analysed. Surgical cure was defined as postsurgical AHI of fewer than five events per hour. Of the 251 patients assessed for AHI, 12 where considered normal, 219 continued with mild sleep apnoea, whilst 20 continued with moderate. Of the 93 patients with complete data available, the surgical success rate (reducing the AHI) was 80.6% and the cure rate to an AHI of five or less, 35.5%. It was concluded that surgical success does not determine the resolution of chronic disease. The low cure rate indicates residual disease. With respect to facial appearance, 38% were very satisfied with their appearance, 26% satisfied, a further 36% indifferent, 8% were disappointed with their appearance of whom 6% were unsatisfied with the results of apnoea surgery. Those patients with a higher AHI pre-surgery, experienced a greater improvement than those with a low pre-surgical AHI. The chance of complete surgical cure was also high in this group. They conclude that maxillomandibular surgery is a successful treatment for obstructive sleep apnoea improving the objective and subjective symptoms with the initial severity of the AHI influencing the success. Changes in facial profile were not thought to be significant sources of concern.

Maxillomandibular advancement as a successful treatment for obstructive sleep apnoea systemic review and meta-analysis.

John CR, Gandy S, Sakharia AR, James TT.

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Stuart Clark

Manchester Royal Infirmary, Manchester, UK.

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