Emilie Garreau

Ostéotomie d'avancée maxillo-mandibulaire ou orthèse d'avancée mandibulaire dans le traitement des syndromes d'apnées obstructives du sommeil modérés à sévères : comparaison d'efficacité et recherche de critères prédictifs d'efficacité

INTRODUCTION Currently, positive airway pressure is the gold standard treatment of obstructive sleep apnea (OSA). Unfortunely, adherence rates are poor. Alternative therapies are mandibular advancement device (MAD) and maxillomandibular advancement (MMA). PATIENTS This retrospective study compared both treatment effectiveness on patients with moderate and severe OSA from January 2005 to September 2012, and carried out predictive factor of effectiveness. We defined therapeutic success as an apnea hypopnea index (AHI) less than 15 per hour and at least a 50% reduction of the initial index. The difference in effectiveness has been studied using regression logistic adjusted on MAD versus MMA propensity score. RESULTS This study included 198 patients. 37 were treated by MMA, and 161 with MAD. MMA treatment was significantly more efficient than MAD treatment with an odds ratio of 3.22; CI95% 1.31Γ7.82 (p = 0.011). Younger age and lower initial AHI were predictive of increased success. There was no significant interaction between the treatment and morphologic patient factors. CONCLUSION In our sample of patients, MMA surgery was significantly more efficient than MAD treatment for the patients with moderate or severe OSA. No morphologic characteristic was identified to determine which patients would benefit most from MAD versus MMA surgery.

Symphyseal distraction in the context of orthodontic treatment: A series of 35 cases

INTRODUCTION Use of symphyseal distraction osteogenesis to treat a mandibular bone deficit with tooth-jaw discrepancy due to lack of space makes it possible to avoid the risks associated with the techniques usually envisaged (stripping, labioversion of incisors, extractions). PATIENTS AND METHOD This retrospective study presents the symphyseal distraction technique used in the maxillofacial surgery department of Lille University Hospital between January 1998 and March 2013. Treatment efficacy, complications and the stability of results were all evaluated. RESULTS Thirty-five patients were included in the study. The gain of inter-mental-foramen space was on average 7 mm (3-12, standard deviation 1.8 mm). A good occlusal result with dental Class I and no labioversion of the lower incisors was obtained in 27 of the 35 patients (77%). CONCLUSION Mandibular distraction by symphyseal osteotomy seems to be a quick, safe treatment for an anterior transversal mandibular deficit giving results that are stable over time. Its success depends on good collaboration between the orthodontist and the surgeon, and on strict patient selection.

Morphological impact on patients of maxillomandibular advancement surgery for the treatment of obstructive sleep apnea-hypopnea syndrome

INTRODUCTION The aim of this study is to evaluate the experience of patients who have benefited from maxillomandibular advancement surgery for the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS), and also the morphological modifications measured on pre- and postoperative lateral headfilms. PATIENTS AND METHODS Twenty-three patients aged 24 to 64 (M=46.8) who had undergone bimaxillary advancement osteotomy for the treatment of OSAHS filled in a questionnaire concerning their overall satisfaction following surgery, the modification of their facial appearance as perceived by themselves and their family and friends, the change in their smile, and the slimmer and more youthful appearance of their face. Measurements of bone and skin points were also performed on lateral cephalograms before and after surgery so as to assess the advancement of the bony bases (maxillary, mandibular and chin advancement) and the impact on soft tissue by analysis of the skin profile. RESULTS A total of 91.3% of the patients were satisfied overall following the surgical procedure; 78.3% considered that their faces were improved or unchanged; 39.1% found their faces slimmer and 34.8% thought they looked more youthful. Average maxillary, mandibular and chin advancements with respect to the base of the skull were, respectively, 7.4mm, 11.1mm and 14.1mm. Advancement of the stomion point with respect to the Frankfurt plane was 8.3mm on average, reflecting a significant forward movement of the upper and lower lips. CONCLUSION Despite greater maxillary and mandibular advancements than in traditional orthognathic surgery, patients reacted positively to these morphological changes, considering in more than a third of cases that their faces looked slimmer or more youthful. It can thus be concluded that overall satisfaction is high, with a morphological impact that is satisfactory and well-accepted by patients postoperatively.

Bone-borne distractor versus tooth-borne distractor for orthodontic distraction after surgical maxillary expansion: The patient's point of view.

INTRODUCTION Orthodontic distraction after surgical maxillary expansion is a mode of treatment regularly used in the context of transverse maxillary constriction. There is, however, no consensus in the literature as to the type of distractor (bone-borne or tooth-borne) that should be used. PATIENTS AND METHOD This retrospective study compared orthodontic distraction using a bone-borne or a tooth-borne distractor from the point of view of tolerance, ease of use and overall patient satisfaction, by means of a questionnaire completed by patients undergoing maxillary expansion surgery in the Stomatology and Maxillofacial Surgery Department of Lille University Hospital between January 2013 and March 2015. The efficacy of the two distractors was also assessed. RESULTS Thirty-two patients were included: 10 in the bone-borne distractor group and 22 in the tooth-borne group. Sixty percent of patients questioned found the bone-borne distractor easy to use compared with 32% for the tooth-borne distractor (P=0.167). Tolerance was noted to be comparable and acceptable by the two groups. The overall satisfaction rate was high for both groups at over 90%, and was correlated with ease of use and clear information. The average space gain between the first molars was 11.1mm with the bone-borne device and 10.7mm for the tooth-borne appliance. CONCLUSION The use of a bone-borne distractor for orthodontic distraction after maxillary expansion surgery appears to be an effective, simple and well-tolerated alternative to the use of a tooth-borne distractor. According to patients, this distractor also appears easier to use than the traditional Hyrax-type distractor. This ease of use is correlated with overall satisfaction.