LAUSR

Several surgical options exist for treating obstructive sleep apnea (OSA), but few correct airway obstruction at multiple levels like maxillomandibular advancement (MMA). MMA has been shown to significantly improve OSA, decrease sleepiness, and also improve quality of life. Despite the accepted success of MMA surgery, it is unclear if patients referred for MMA undergo MMA or are lost to follow-up in real world clinical care. This quality improvement study aims to determine if patients referred for MMA by ENT sleep surgeons then undergo MMA surgery by oral maxillofacial surgeons (OMFS). At our academic urban hospital, all drug induced sleep endoscopy (DISE) cases performed on OSA patients by two otolaryngology sleep surgeons were reviewed over a one year period. Patients who were not recommended for MMA based on DISE findings were excluded. Retrospective chart review included VOTE classification, DISE findings, and referrals for MMA to the OMFS clinic. Other data included age, BMI, past medical history, sleep study data including AHI and oxygen nadir, and if MMA or other OSA treatments were done. Out of 408 DISE performed, 58 patients (14.2%) were referred to our OMFS for MMA. Patients’ demographics were: male (48; 82.8%); average age: 51; average BMI: 32.5; 39 (67.2%) with comorbidities. Sleep studies included: 32 HSATs, 22 PSGs, 4 missing. 41 patients (75.9%) had severe OSA. Average O2 nadir was 75%. On DISE, most patients had some level of obstruction at all anatomic subsites (94.8%). All patients had complete obstruction at the level of the palate or velum. 41 (70.7%) also had additional anatomic abnormalities noted including maxillary constriction, midface hypoplasia, retrognathia or micrognathia. From 58 patients recommended for MMA, 35 (60.3%) followed up in OMFS clinic and 11 (31.4%) underwent MMA surgery. Five patients (14.3%) received OATs. 11 patients (19%) had CPAP re-evaluation. 27 patients (46.6%) were lost to follow-up. Of patients referred by ENT to OMFS following DISE, only 60% were seen at OMFS clinic and only half of these patients underwent MMA. While some received other treatments, nearly half were lost to follow-up altogether. We propose a revised workflow to improve patient education, acceptance, and coordination of OSA care and follow-up.