Virtual Guided and Customized Orthognathic Surgery in Patients with Obstructive Sleep Apnea Syndrome: Accuracy and Clinical Outcomes

This preliminary case series aimed to evaluate the clinical and morphometric outcomes of maxillomandibular advancement (MMA) surgery in patients with severe obstructive sleep apnea (OSA) using virtual surgical planning (VSP), patient-specific cutting guides, and customized titanium plates. Primary o...

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Autores: Benito Anguita, Marta, Khayat, Saad, López Martín, Soledad, Bravo Quelle, Natalia, Navarro Cuéllar, Ignacio, López López, Ana, Tousidonis Rial, Manuel, Falahat Noushzady, Farzin, Zamorano León, José Javier, Navarro Cuéllar, Carlos
Tipo de documento: artigo
Data de publicação:2025
País:España
Recursos:Universidad Complutense de Madrid (UCM)
Repositório:Docta Complutense
Idioma:inglês
OAI Identifier:oai:docta.ucm.es:20.500.14352/131406
Acesso em linha:https://hdl.handle.net/20.500.14352/131406
Access Level:Acceso aberto
Palavra-chave:617.52:616.248-089
orthognathic surgery
obstructive sleep apnea
CAD/CAM technology
virtual surgical planning
cutting guides
customized plates
Ciencias Biomédicas
32 Ciencias Médicas
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spelling Virtual Guided and Customized Orthognathic Surgery in Patients with Obstructive Sleep Apnea Syndrome: Accuracy and Clinical OutcomesBenito Anguita, MartaKhayat, SaadLópez Martín, SoledadBravo Quelle, NataliaNavarro Cuéllar, IgnacioLópez López, AnaTousidonis Rial, ManuelFalahat Noushzady, FarzinZamorano León, José JavierNavarro Cuéllar, Carlos617.52:616.248-089orthognathic surgeryobstructive sleep apneaCAD/CAM technologyvirtual surgical planningcutting guidescustomized platesCiencias Biomédicas32 Ciencias MédicasThis preliminary case series aimed to evaluate the clinical and morphometric outcomes of maxillomandibular advancement (MMA) surgery in patients with severe obstructive sleep apnea (OSA) using virtual surgical planning (VSP), patient-specific cutting guides, and customized titanium plates. Primary outcomes included changes in the Apnea–Hypopnea Index (AHI), airway dimensions, surgical accuracy, and quality of life. Methods: In this preliminary case series, six patients with severe OSA underwent MMA surgery planned using three-dimensional VSP, and executed with the aid of CAD-/CAM-generated surgical guides and patient-specific osteosynthesis. Clinical variables included AHI, Epworth Sleepiness Scale (ESS), and computed tomography-based airway morphometry. Surgical accuracy was assessed by comparing planned and achieved skeletal movements. Statistical analysis was performed using Wilcoxon signed-rank tests and Spearman’s correlation. Results: The mean preoperative AHI decreased significantly from 48.8 ± 23.6 to 12.4 ± 10.0 (p = 0.035), and ESS scores improved from 14.5 ± 4.6 to 7.8 ± 2.1 (p = 0.029). Mean airway area increased significantly from 51.8 ± 9.0 mm2 to 91.8 ± 26.6 mm2 (p = 0.035). A strong but non-significant correlation was observed between airway gain and ESS improvement (p = 0.754, p = 0.084). No patients required CPAP at 6-month follow-up, and all were asymptomatic. The anteroposterior accuracy of skeletal movements was high: 82.6% for the maxilla and 85.8% for the pogonion, with mean absolute errors of 1.25 mm and 1.95 mm, respectively. Vertical accuracy was lower, particularly in the chin region, where error analysis showed greater variability. No statistically significant differences were found between planned and achieved movements in any vector. Conclusions: MMA surgery performed with VSP, cutting guides, and customized titanium plates offers a highly effective, safe, and precise treatment modality for selected OSA patients. This approach leads to a significant reduction in AHI, expansion of the upper airway, and improvement in patient-reported daytime functioning. High accuracy in skeletal repositioning—particularly in anteroposterior vectors—supports the reliability and reproducibility of digitally guided orthognathic surgery. These findings reinforce the role of technologically assisted MMA as a definitive treatment for severe OSA.MDPIUniversidad Complutense de Madrid20252025-05-2820252025-05-28journal articlehttp://purl.org/coar/resource_type/c_6501VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttps://hdl.handle.net/20.500.14352/131406reponame:Docta Complutenseinstname:Universidad Complutense de Madrid (UCM)Inglésengopen accesshttp://purl.org/coar/access_right/c_abf2Attribution 4.0 Internationalhttp://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:docta.ucm.es:20.500.14352/1314062026-06-02T12:44:21Z
dc.title.none.fl_str_mv Virtual Guided and Customized Orthognathic Surgery in Patients with Obstructive Sleep Apnea Syndrome: Accuracy and Clinical Outcomes
title Virtual Guided and Customized Orthognathic Surgery in Patients with Obstructive Sleep Apnea Syndrome: Accuracy and Clinical Outcomes
spellingShingle Virtual Guided and Customized Orthognathic Surgery in Patients with Obstructive Sleep Apnea Syndrome: Accuracy and Clinical Outcomes
Benito Anguita, Marta
617.52:616.248-089
orthognathic surgery
obstructive sleep apnea
CAD/CAM technology
virtual surgical planning
cutting guides
customized plates
Ciencias Biomédicas
32 Ciencias Médicas
title_short Virtual Guided and Customized Orthognathic Surgery in Patients with Obstructive Sleep Apnea Syndrome: Accuracy and Clinical Outcomes
title_full Virtual Guided and Customized Orthognathic Surgery in Patients with Obstructive Sleep Apnea Syndrome: Accuracy and Clinical Outcomes
title_fullStr Virtual Guided and Customized Orthognathic Surgery in Patients with Obstructive Sleep Apnea Syndrome: Accuracy and Clinical Outcomes
title_full_unstemmed Virtual Guided and Customized Orthognathic Surgery in Patients with Obstructive Sleep Apnea Syndrome: Accuracy and Clinical Outcomes
title_sort Virtual Guided and Customized Orthognathic Surgery in Patients with Obstructive Sleep Apnea Syndrome: Accuracy and Clinical Outcomes
dc.creator.none.fl_str_mv Benito Anguita, Marta
Khayat, Saad
López Martín, Soledad
Bravo Quelle, Natalia
Navarro Cuéllar, Ignacio
López López, Ana
Tousidonis Rial, Manuel
Falahat Noushzady, Farzin
Zamorano León, José Javier
Navarro Cuéllar, Carlos
author Benito Anguita, Marta
author_facet Benito Anguita, Marta
Khayat, Saad
López Martín, Soledad
Bravo Quelle, Natalia
Navarro Cuéllar, Ignacio
López López, Ana
Tousidonis Rial, Manuel
Falahat Noushzady, Farzin
Zamorano León, José Javier
Navarro Cuéllar, Carlos
author_role author
author2 Khayat, Saad
López Martín, Soledad
Bravo Quelle, Natalia
Navarro Cuéllar, Ignacio
López López, Ana
Tousidonis Rial, Manuel
Falahat Noushzady, Farzin
Zamorano León, José Javier
Navarro Cuéllar, Carlos
author2_role author
author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Universidad Complutense de Madrid
dc.subject.none.fl_str_mv 617.52:616.248-089
orthognathic surgery
obstructive sleep apnea
CAD/CAM technology
virtual surgical planning
cutting guides
customized plates
Ciencias Biomédicas
32 Ciencias Médicas
topic 617.52:616.248-089
orthognathic surgery
obstructive sleep apnea
CAD/CAM technology
virtual surgical planning
cutting guides
customized plates
Ciencias Biomédicas
32 Ciencias Médicas
description This preliminary case series aimed to evaluate the clinical and morphometric outcomes of maxillomandibular advancement (MMA) surgery in patients with severe obstructive sleep apnea (OSA) using virtual surgical planning (VSP), patient-specific cutting guides, and customized titanium plates. Primary outcomes included changes in the Apnea–Hypopnea Index (AHI), airway dimensions, surgical accuracy, and quality of life. Methods: In this preliminary case series, six patients with severe OSA underwent MMA surgery planned using three-dimensional VSP, and executed with the aid of CAD-/CAM-generated surgical guides and patient-specific osteosynthesis. Clinical variables included AHI, Epworth Sleepiness Scale (ESS), and computed tomography-based airway morphometry. Surgical accuracy was assessed by comparing planned and achieved skeletal movements. Statistical analysis was performed using Wilcoxon signed-rank tests and Spearman’s correlation. Results: The mean preoperative AHI decreased significantly from 48.8 ± 23.6 to 12.4 ± 10.0 (p = 0.035), and ESS scores improved from 14.5 ± 4.6 to 7.8 ± 2.1 (p = 0.029). Mean airway area increased significantly from 51.8 ± 9.0 mm2 to 91.8 ± 26.6 mm2 (p = 0.035). A strong but non-significant correlation was observed between airway gain and ESS improvement (p = 0.754, p = 0.084). No patients required CPAP at 6-month follow-up, and all were asymptomatic. The anteroposterior accuracy of skeletal movements was high: 82.6% for the maxilla and 85.8% for the pogonion, with mean absolute errors of 1.25 mm and 1.95 mm, respectively. Vertical accuracy was lower, particularly in the chin region, where error analysis showed greater variability. No statistically significant differences were found between planned and achieved movements in any vector. Conclusions: MMA surgery performed with VSP, cutting guides, and customized titanium plates offers a highly effective, safe, and precise treatment modality for selected OSA patients. This approach leads to a significant reduction in AHI, expansion of the upper airway, and improvement in patient-reported daytime functioning. High accuracy in skeletal repositioning—particularly in anteroposterior vectors—supports the reliability and reproducibility of digitally guided orthognathic surgery. These findings reinforce the role of technologically assisted MMA as a definitive treatment for severe OSA.
publishDate 2025
dc.date.none.fl_str_mv 2025
2025-05-28
2025
2025-05-28
dc.type.none.fl_str_mv journal article
http://purl.org/coar/resource_type/c_6501
VoR
http://purl.org/coar/version/c_970fb48d4fbd8a85
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://hdl.handle.net/20.500.14352/131406
url https://hdl.handle.net/20.500.14352/131406
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv MDPI
publisher.none.fl_str_mv MDPI
dc.source.none.fl_str_mv reponame:Docta Complutense
instname:Universidad Complutense de Madrid (UCM)
instname_str Universidad Complutense de Madrid (UCM)
reponame_str Docta Complutense
collection Docta Complutense
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15.812455

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