Maxillomandibular Advancement in the Treatment of Obstructive Sleep Apnea

NCT ID: NCT03796078

Last Updated: 2023-05-16

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

80 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-04-30

Study Completion Date

2025-12-01

Brief Summary

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ABSTRACT OBJECTIVES: To study the correlation between pharyngeal airway volume (PAV), the clinical indicators of obstructive sleep apnea (AHI, ESS), and the impact of orthognathic surgery on them.

METHODS: A prospective, descriptive, unicentric study carried out by a multidisciplinary team to evaluate the following parameters in patients undergoing orthognathic surgery at Maxillofacial institute Teknon medical center.

During the study period:

* Record of the type, magnitude and direction of surgical movements of the maxillofacial complex made during the surgery (Day 0-Month 1).
* Assessment of PAS/PAV stability (relapse) at short term (1 month).

3D PAV assessment by cranial voxel-based superimposition protocol before and one month and 12 months after orthognathic surgery.
* Household polysomnography (PSG) registry/ apnea-hypopnea index (Day 0, Month 1 and Month 12). (AHI evaluation bu neurophysiologist)
* Assessment of the clinical indicators of obstructive sleep apnea at day 0, month 1 and month 12:, blood pressure (mm Hg) , and daytime hypersomnia test (Epworth sleepiness scale, ESS) (Day 0, Month 1 and Month 12).
* Record of body mass index (BMI) (cm/Kg2)

Main Objective:

• Evaluate the impact of orthognathic surgery (bimaxillary or monomaxillary) and its movements on the PAV and the clinical indicators of OSA.

Specific objectives:

• Interrelate the degree of dentofacial deformity with the IAH.

* Study the potential correlation between the volume of the VAS and the IAH.
* Correlate the type, direction and magnitude of the surgical movements of the maxillofacial complex with PAV/PAS increase Correlate the type, direction and magnitude of the surgical movements of the maxillofacial complex with the cure of OSA (household PSG AHI assessment) and the following clinical indicators of OSA: diurnal hypersomnia test (ESD, ESS).
* Evaluate negative effects of either maxillary or mandibular surgical movements in PAS/PAV increase and the cures of OSA.

Evaluate negative effects of either maxillary or mandibular surgical movements in the improvement of the clinical symptoms and the cure of OSA.

* To study the possible effect of surgical complications on PAS/PAV stability at long term and the clinical symptoms of OSA.
* Demonstrate that maxillomandibular surgery is a defined, predictable and a definitive cure for OSA.
* Demonstrate that skeletal, linear, and cross-sectional volume parameters remain stable at long-term.
* Demonstrate that AHI and OSA-related parameters stay stable at long term after mono- or bimaxillary surgery.

Hypothesis

* H1a: Maxillomandibular advancement (orthognathic surgery) does correlate with the volume of the upper airway, at both short or long term.
* H2a: Maxillomandibular advancement (orthognathic surgery) does correlate with the clinical indicators of obstructive sleep apnea, at both short or long term.

Detailed Description

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Conditions

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OSA OSAS Apnea, Obstructive Sleep Orthognathic Surgery

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Bimaxillary surgery (MMA)

Bimaxillary Orthognathic Surgery. MMA

Group Type ACTIVE_COMPARATOR

Maxillomandibular advancement

Intervention Type PROCEDURE

Treatment: Mono or Bimaxillary Orthognathic Surgery. The surgery of Reposition of the jaws is carried out under general anesthesia using minimally invasive techniques, the patient is extubated After surgery, antibiotics are prescribed during admission, anti-inflammatories, antiemetics and a local cold mask is applied of closed circuit at 17ºCelsius. The patient is discharged at 24 h.

monomaxillary surgery (Isolated MaxS)

Monomaxillary surgery (Isolated MaxS)

Group Type ACTIVE_COMPARATOR

monomaxillary surgery (isolated MaxS)

Intervention Type PROCEDURE

Monomaxillary surgery (Isolated MaxS): The surgery of Reposition of the maxilla is carried out under general anesthesia using minimally invasive techniques, the patient is extubated After surgery, antibiotics are prescribed during admission, anti-inflammatories, antiemetics and a local cold mask is applied of closed circuit at 17ºCelsius. The patient is discharged at 24 h.

monomandibullary surgery (Isolated MandS)

Monomandibular surgery (Isolated MandS)

Group Type ACTIVE_COMPARATOR

monomandibullary surgery (MandS)

Intervention Type PROCEDURE

Monomandibullary surgery (Isolated MandS): The surgery of Reposition of the maxilla is carried out under general anesthesia using minimally invasive techniques, the patient is extubated After surgery, antibiotics are prescribed during admission, anti-inflammatories, antiemetics and a local cold mask is applied of closed circuit at 17ºCelsius. The patient is discharged at 24 h.

Interventions

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Maxillomandibular advancement

Treatment: Mono or Bimaxillary Orthognathic Surgery. The surgery of Reposition of the jaws is carried out under general anesthesia using minimally invasive techniques, the patient is extubated After surgery, antibiotics are prescribed during admission, anti-inflammatories, antiemetics and a local cold mask is applied of closed circuit at 17ºCelsius. The patient is discharged at 24 h.

Intervention Type PROCEDURE

monomaxillary surgery (isolated MaxS)

Monomaxillary surgery (Isolated MaxS): The surgery of Reposition of the maxilla is carried out under general anesthesia using minimally invasive techniques, the patient is extubated After surgery, antibiotics are prescribed during admission, anti-inflammatories, antiemetics and a local cold mask is applied of closed circuit at 17ºCelsius. The patient is discharged at 24 h.

Intervention Type PROCEDURE

monomandibullary surgery (MandS)

Monomandibullary surgery (Isolated MandS): The surgery of Reposition of the maxilla is carried out under general anesthesia using minimally invasive techniques, the patient is extubated After surgery, antibiotics are prescribed during admission, anti-inflammatories, antiemetics and a local cold mask is applied of closed circuit at 17ºCelsius. The patient is discharged at 24 h.

Intervention Type PROCEDURE

Other Intervention Names

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MMA (maxillomandibular advancement)

Eligibility Criteria

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Inclusion Criteria

1. Patients over 18 years of age who present any kind of dentofacial deformity candidates for orthognathic surgery treatment.
2. Growth of the maxillofacial complex completed.
3. Patients without uncontrolled cardio-pulmonary disease.
4. Patients willing to understand the procedures of the study and that agree to give their signed informed consent.
5. Patients who commit to perform the postoperative controls for at least one postoperative year.
6. Patients with a good general condition of health, confirmed by pre-operative study and assessment by Anaesthesiology (ASA).

Exclusion Criteria

1. Patients with a clinical history in which any surgery would be contraindicated
2. Patients with any facial Syndromic malformation
3. Patients who have undergone chemotherapy or radiotherapy during the last 5 years, including area of head and neck.
4. Patients who refuse to accept the clinical conditions of the study and are not willing to sign the form corresponding informed consent.
5. Patients who are expected to lack adherence to follow-up or to the treatment.
6. Treatment with bisphosphonates or Denosumab (Prolia®).
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Centro Medico Teknon

OTHER

Sponsor Role lead

Responsible Party

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Dr. Federico Hernández-Alfaro MD, DDS, PhD, FEBOMS

Chief Oral and Maxillofacial Surgery Department

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Federico Hernández-Alfaro, PhD

Role: STUDY_CHAIR

Institute of Maxillofacial Surgery, Teknon Medical Center

Adaia Valls-Ontañón, PhD

Role: PRINCIPAL_INVESTIGATOR

Institute of Maxillofacial Surgery, Teknon Medical Center

Locations

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Institute of Maxillofacial Surgery, Teknon Medical Center

Barcelona, , Spain

Site Status RECRUITING

Countries

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Spain

Central Contacts

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Maria Giralt-Hernando, PhD

Role: CONTACT

+34933 933 185 ext. 112

Adaia Valls-Ontañón, PhD

Role: CONTACT

+34933 933 185 ext. 112

Facility Contacts

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Maria Giralt-Hernando, MSC

Role: primary

+34933 933 185 ext. 112

Adaia Valls-Ontañón, PhD

Role: backup

+34933 933 185 ext. 112

References

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Giralt-Hernando M, Valls-Ontanon A, Guijarro-Martinez R, Masia-Gridilla J, Hernandez-Alfaro F. Impact of surgical maxillomandibular advancement upon pharyngeal airway volume and the apnoea-hypopnoea index in the treatment of obstructive sleep apnoea: systematic review and meta-analysis. BMJ Open Respir Res. 2019 Oct 9;6(1):e000402. doi: 10.1136/bmjresp-2019-000402. eCollection 2019.

Reference Type BACKGROUND
PMID: 31673361 (View on PubMed)

Giralt-Hernando M, Valls-Ontanon A, Haas Junior OL, Masia-Gridilla J, Hernandez-Alfaro F. What are the Surgical Movements in Orthognathic Surgery That Most Affect the Upper Airways? A Three-Dimensional Analysis. J Oral Maxillofac Surg. 2021 Feb;79(2):450-462. doi: 10.1016/j.joms.2020.10.017. Epub 2020 Oct 15.

Reference Type BACKGROUND
PMID: 33171114 (View on PubMed)

Hernandez-Alfaro F, Giralt-Hernando M, Brabyn PJ, Haas OL Jr, Valls-Ontanon A. Variation between natural head orientation and Frankfort horizontal planes in orthognathic surgery patients: 187 consecutive cases. Int J Oral Maxillofac Surg. 2021 Sep;50(9):1226-1232. doi: 10.1016/j.ijom.2021.02.011. Epub 2021 Feb 22.

Reference Type BACKGROUND
PMID: 33632574 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Document Type: Informed Consent Form

View Document

Other Identifiers

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OSAS-OS

Identifier Type: -

Identifier Source: org_study_id

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