P177 Patient reported outcome measures (PROMS) following maxillomandibular advancement (MMA) surgery in patients with obstructive sleep apnoea syndrome

• Published in: Thorax Vol. 74; no. Suppl 2; p. A186
• Main Authors: Martin, MJ, Khanna, A, Srinivasan, D, Sovani, MP
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.12.2019
• Subjects: Patient satisfaction; Quality of life; Sleep; Surgery
• ISSN: 0040-6376; 1468-3296
• DOI: 10.1136/thorax-2019-BTSabstracts2019.320

BackgroundMMA is an effective treatment option for OSAS refractory to conventional treatment. However, MMA is a highly invasive procedure with a number of recognised side effects and few data exist on the effect of MMA on metrics likely to be of prime importance to patients such as quality of life.1 Here we describe a case series of patients selected for MMA through our joint respiratory/maxillofacial surgery clinic detailing the effect of MMA on objective physiological measurements and important PROMS.MethodsPatients with confirmed moderate/severe symptomatic OSAS intolerant to CPAP/MAD were assessed in the joint clinic for evaluation and consideration of MMA. Pre and post-operative X-ray airway measurements, AHI, ESS and quality of life on a 10 point Likert scale were recorded. A custom questionnaire was administered post-operatively to assess a number of psychosocial and functional domains (sleep quality, energy levels, appearance, ability to perform daily activities, mood) and patient satisfaction using 5 point Likert scales.ResultsOver an 18 month period, 39 patients were referred to the clinic for assessment for MMA. 10 patients underwent the surgery of whom 8 (5 men) with mean age of 50 and mean BMI of 27.6 completed all PROMS.Surgery resulted in significant improvements in ESS (mean pre-op 14.1, post-op 4.5, p<0.001), quality of life (mean pre-op 2.8, post-op 7.9, p<0.01), AHI (mean 22.2 events/hour pre-op to 9.9 events/hour post-op; p=0.03) and airway diameters. All patients reported improvements in all psychosocial/functional domains except for appearance, in which 5/8 (63%) reported improvements and 3/8 (37%) reported no change or worsened appearance. All subjects were satisfied with the results of the surgery and felt it provided better symptom control than CPAP. Side effects were reported in all subjects, most commonly facial/lip numbness (n=7/8, 88%) and affected bite (n=4/8, 50%).ConclusionsMMA resulted in significant improvements in ESS, quality of life and a range of PROMS and there was a high level of satisfaction with the procedure. Commonly reported side effects included facial/lip numbness and affected bite.ReferenceButterfield KJ, et al. Quality of life assessment after maxillomandibular advancement surgery for obstructive sleep apnea. J Oral Maxillofac Surg 2016;74(6):1228–37.