Persistent OSA After Maxillomandibular Advancement: Insights From Drug‐Induced Sleep Endoscopy

Abstract Objective To examine drug‐induced sleep endoscopy (DISE) findings in individuals with persistent obstructive sleep apnea (OSA) after maxillomandibular advancement (MMA). Study Design Cross‐sectional. Setting Academic medical center. Methods DISE using propofol for unconscious sedation was performed in adult study participants with OSA after MMA and possible other procedures, defined by a postoperative apnea‐hypopnea index ≥ 5 events/h. The pattern of obstruction during DISE in the supine body position was characterized using the VOTE Classification. Results Twenty‐four study participants underwent DISE examinations. Age was 46.4 ± 10.5 years, and 12% (3/24) were female. Body mass index was 26.4 ± 4.7 kg/m 2 . DISE examinations were performed 889 ± 1009 days after MMA. The post‐MMA apnea‐hypopnea index was 18.2 ± 11.3 events/h. During DISE, most study participants demonstrated tongue‐related obstruction, with a substantial minority showing velum‐ and epiglottis‐related obstruction. Oropharyngeal lateral wall‐related obstruction was less common. Compared to a larger cohort (n = 810) with no previous pharyngeal OSA surgery undergoing DISE, velum‐ and oropharyngeal lateral wall‐related obstruction were less common, and epiglottis‐related obstruction was more common. Conclusion Among individuals with OSA following MMA, upper airway obstruction occurs due to multiple potential anatomic structures. Tongue‐related obstruction is common, and epiglottis‐related obstruction is more common than in those without previous pharyngeal OSA surgery.