{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T18:07:28Z","timestamp":1782842848508,"version":"3.54.5"},"reference-count":48,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2023,10,22]],"date-time":"2023-10-22T00:00:00Z","timestamp":1697932800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>This retrospective study aimed to: (1) investigate the surgical accuracy of maxillomandibular advancement (MMA) in obstructive sleep apnea (OSA) patients, with a specific focus on maxillary and mandibular advancement and counter-clockwise rotation and (2) investigate the correlation between the amount of achieved advancement and the reduction in the relative apnea hypopnea index (AHI). Sixteen patients, for whom a three-dimensional virtual surgical plan was generated preoperatively and a computed tomography scan (CT) or cone-beam computer tomography (CBCT) was acquired postoperatively, were included. The postoperative CT or CBCT was compared to the virtual surgical plan, and differences in the mandibular and maxillary advancement and counter-clockwise rotation were assessed. Maxillary and mandibular advancement (median 3.1 mm, p = 0.002 and 2.3 mm, p = 0.03, respectively) and counter-clockwise rotation (median 3.7\u00b0, p = 0.006 and 4.7\u00b0, p = 0.001, respectively) were notably less than intended. A significant correlation was found between the planned maxillary advancement and the difference between the planned and actual maxillary advancement (p = 0.048; adjusted R2 = 0.1979) and also between the planned counter-clockwise rotation and the difference between the planned and actual counter-clockwise rotation for the mandible (p = 0.012; adjusted R2 = 0.3261). Neither the maxilla-first nor the mandible-first surgical sequence proved to be superior in terms of the ability to achieve the intended movements (p &gt; 0.45). Despite a significant reduction (p = 0.001) in the apnea hypopnea index (AHI) from a median of 62.6 events\/h to 19.4 events\/h following MMA, no relationship was found between the extent of maxillary or mandibular advancement and AHI improvement in this small cohort (p = 0.389 and p = 0.387, respectively). This study underlines the necessity for surgeons and future research projects to be aware of surgical inaccuracies in MMA procedures for OSA patients. Additionally, further research is required to investigate if sufficient advancement is an important factor associated with MMA treatment outcome.<\/jats:p>","DOI":"10.3390\/jpm13101517","type":"journal-article","created":{"date-parts":[[2023,10,22]],"date-time":"2023-10-22T07:02:53Z","timestamp":1697958173000},"page":"1517","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Assessment of Surgical Accuracy in Maxillomandibular Advancement Surgery for Obstructive Sleep Apnea: A Preliminary Analysis"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8396-2501","authenticated-orcid":false,"given":"Jean-Pierre T. F.","family":"Ho","sequence":"first","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands"},{"name":"Academic Centre for Dentistry of Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands"},{"name":"Department of Oral and Maxillofacial Surgery, Northwest Clinics, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1927-3784","authenticated-orcid":false,"given":"Ning","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8271-4821","authenticated-orcid":false,"given":"Tom C. T.","family":"van Riet","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands"},{"name":"Academic Centre for Dentistry of Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruud","family":"Schreurs","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6371-4671","authenticated-orcid":false,"given":"Alfred G.","family":"Becking","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands"},{"name":"Academic Centre for Dentistry of Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0096-8217","authenticated-orcid":false,"given":"Jan","family":"de Lange","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands"},{"name":"Academic Centre for Dentistry of Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,10,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/S0140-6736(02)09464-3","article-title":"Obstructive sleep apnoea","volume":"360","author":"Malhotra","year":"2002","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.1001\/jama.2020.3514","article-title":"Diagnosis and Management of Obstructive Sleep Apnea: A Review","volume":"323","author":"Gottlieb","year":"2020","journal-title":"JAMA"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2013","DOI":"10.1001\/jama.291.16.2013","article-title":"Risk factors for obstructive sleep apnea in adults","volume":"291","author":"Young","year":"2004","journal-title":"JAMA"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"509","DOI":"10.17219\/dmp\/130099","article-title":"Correlation between the upper airway volume and the hyoid bone position, palatal depth, nasal septum deviation, and concha bullosa in different types of malocclusion: A retrospective cone-beam computed tomography study","volume":"58","author":"Dastan","year":"2021","journal-title":"Dent. Med. Probl."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"121","DOI":"10.17219\/dmp\/154776","article-title":"Comparison of the pharyngeal airway in snoring and non-snoring patients based on the lateral cephalometric study: A case-control study","volume":"60","author":"Tofangchiha","year":"2023","journal-title":"Dent. Med. Probl."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1016\/S0140-6736(81)92140-1","article-title":"Reversal of Obstructive Sleep Apnoea by Continuous Positive Airway Pressure Applied Through the Nares","volume":"317","author":"Sullivan","year":"1981","journal-title":"Lancet"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"301","DOI":"10.5664\/jcsm.7638","article-title":"Treatment of adult obstructive sleep apnea with positive airway pressure: An American academy of sleep medicine systematic review, meta-analysis, and GRADE assessment","volume":"15","author":"Patil","year":"2019","journal-title":"J. Clin. Sleep. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"263","DOI":"10.5664\/jcsm.27497","article-title":"Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults","volume":"5","author":"Epstein","year":"2009","journal-title":"J. Clin. Sleep. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1183\/09031936.00144711","article-title":"Non-CPAP therapies in obstructive sleep apnoea: Mandibular advancement device therapy","volume":"39","author":"Marklund","year":"2012","journal-title":"Eur. Respir. J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2499","DOI":"10.5664\/jcsm.9592","article-title":"Referral of adults with obstructive sleep apnea for surgical consultation: An American Academy of Sleep Medicine clinical practice guideline","volume":"17","author":"Kent","year":"2021","journal-title":"J. Clin. Sleep. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"101471","DOI":"10.1016\/j.smrv.2021.101471","article-title":"Maxillomandibular advancement versus multilevel surgery for treatment of obstructive sleep apnea: A systematic review and meta-analysis","volume":"57","author":"Zhou","year":"2021","journal-title":"Sleep. Med. Rev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1016\/j.smrv.2009.11.003","article-title":"Maxillomandibular advancement for the treatment of obstructive sleep apnea: A systematic review and meta-analysis","volume":"14","author":"Holty","year":"2010","journal-title":"Sleep. Med. Rev."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1001\/jamaoto.2015.2678","article-title":"Maxillomandibular advancement for treatment of obstructive sleep apnea a meta-analysis","volume":"142","author":"Zaghi","year":"2016","journal-title":"JAMA Otolaryngol. Head. Neck Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.cxom.2018.11.011","article-title":"Maxillomandibular Advancement: Contemporary Approach at Stanford","volume":"27","author":"Liu","year":"2019","journal-title":"Atlas Oral. Maxillofac. Surg. Clin. North. Am."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1016\/S0272-5231(03)00016-9","article-title":"Surgical management of obstructive sleep apnea","volume":"24","author":"Li","year":"2003","journal-title":"Clin. Chest Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"00126","DOI":"10.1183\/23120541.00126-2022","article-title":"Current and Novel Treatment Options for OSA","volume":"8","author":"Randerath","year":"2022","journal-title":"ERJ Open Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1363","DOI":"10.1016\/j.ijom.2017.07.003","article-title":"Maxillomandibular advancement as the initial treatment of obstructive sleep apnoea: Is the mandibular occlusal plane the key?","volume":"46","author":"Landete","year":"2017","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"9314","DOI":"10.1038\/s41598-017-09488-4","article-title":"Achievability of 3D planned bimaxillary osteotomies: Maxilla-first versus mandible-first surgery","volume":"7","author":"Liebregts","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.bjoms.2016.01.025","article-title":"Natural position of the head: Review of two-dimensional and three-dimensional methods of recording","volume":"54","author":"Cassi","year":"2016","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e271","DOI":"10.1097\/GOX.0000000000000127","article-title":"The modifications of the sagittal ramus split osteotomy: A literature review","volume":"2","author":"Meyns","year":"2014","journal-title":"Plast. Reconstr. Surgery Glob. Open"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1001\/jamaoto.2019.1448","article-title":"Perioperative Care of Patients with Obstructive Sleep Apnea Undergoing Upper Airway Surgery","volume":"145","author":"Ravesloot","year":"2019","journal-title":"JAMA Otolaryngol. Neck Surg."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Baan, F., Liebregts, J., Xi, T., Schreurs, R., De Koning, M., Berg\u00e9, S., and Maal, T. (2016). A new 3D tool for assessing the accuracy of bimaxillary surgery: The OrthoGnathicanAlyser. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0149625"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"597","DOI":"10.5664\/jcsm.2172","article-title":"Rules for scoring respiratory events in sleep: Update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine","volume":"8","author":"Berry","year":"2012","journal-title":"J. Clin. Sleep Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1093\/sleep\/19.2.156","article-title":"The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome","volume":"19","author":"Sher","year":"1996","journal-title":"Sleep"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.joms.2012.03.027","article-title":"Accuracy of a computer-aided surgical simulation protocol for orthognathic surgery: A prospective multicenter study","volume":"71","author":"Hsu","year":"2013","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"3000","DOI":"10.1038\/s41598-019-39250-x","article-title":"One-year postoperative skeletal stability of 3D planned bimaxillary osteotomies: Maxilla-first versus mandible-first surgery","volume":"9","author":"Liebregts","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"74","DOI":"10.4041\/kjod.2013.43.2.74","article-title":"Condylar repositioning using centric relation bite in bimaxillary surgery","volume":"43","author":"Lee","year":"2013","journal-title":"Korean J. Orthod."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1882","DOI":"10.1016\/j.joms.2019.03.023","article-title":"Does Mandible-First Sequencing Increase Maxillary Surgical Accuracy in Bimaxillary Procedures?","volume":"77","author":"Stokbro","year":"2019","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Pamp\u00edn Mart\u00ednez, M.M., Guti\u00e9rrez Venturini, A., de Cevallos, J., Blanco, M.B., Ni\u00f1o, I.A., S\u00e1nchez, A.M., Vera, J.L.d.C.P.d., and Carretero, J.L.C. (2022). Evaluation of the Predictability and Accuracy of Orthognathic Surgery in the Era of Virtual Surgical Planning. Appl. Sci., 12.","DOI":"10.3390\/app12094305"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2217","DOI":"10.1016\/j.joms.2010.10.053","article-title":"Sequencing bimaxillary surgery: Mandible first","volume":"69","author":"Perez","year":"2011","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2225","DOI":"10.1016\/j.joms.2010.10.050","article-title":"Sequencing of two-jaw surgery: The case for operating on the maxilla first","volume":"69","author":"Turvey","year":"2011","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1097\/01.scs.0000179746.98789.0f","article-title":"Retrospective study of 18 patients treated by maxillomandibular advancement with adjunctive procedures for obstructive sleep apnea syndrome","volume":"16","author":"Smatt","year":"2005","journal-title":"J. Craniofac. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1357","DOI":"10.1016\/j.ijom.2017.06.006","article-title":"Assessment of obstructive sleep apnoea treatment success or failure after maxillomandibular advancement","volume":"46","author":"Apperloo","year":"2017","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1016\/j.joms.2007.11.031","article-title":"Quality of life evaluation of maxillomandibular advancement surgery for treatment of obstructive sleep apnea","volume":"66","author":"Lye","year":"2008","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1567","DOI":"10.1007\/s11325-022-02731-x","article-title":"Maxillomandibular advancement for obstructive sleep apnea: A retrospective prognostic factor study for surgical response","volume":"27","author":"Zhou","year":"2022","journal-title":"Sleep. Breath. October"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1002\/alr.23079","article-title":"International Consensus Statement on Obstructive Sleep Apnea","volume":"13","author":"Chang","year":"2023","journal-title":"Int. Forum Allergy Rhinol."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Ho, J.-P.T.F., Zhou, N., and de Lange, J. (2023). Obstructive Sleep Apnea Resolution in Hypopnea-Predominant versus Apnea-Predominant Patients after Maxillomandibular Advancement. J. Clin. Med., 12.","DOI":"10.3390\/jcm12010311"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1016\/j.jcms.2022.06.005","article-title":"Central and mixed sleep apnea related to patients treated with maxillomandibular advancement for obstructive sleep apnea : A retrospective cohort study","volume":"50","author":"Ho","year":"2022","journal-title":"J. Cranio-Maxillofacial Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"73","DOI":"10.5664\/jcsm.8126","article-title":"The influence of position dependency on surgical success in patients with obstructive sleep apnea undergoing maxillomandibular advancement","volume":"16","author":"Vonk","year":"2020","journal-title":"J. Clin. Sleep. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1016\/j.jcms.2017.02.021","article-title":"The use of patient-specific implants in orthognathic surgery: A series of 30 mandible sagittal split osteotomy patients","volume":"45","author":"Suojanen","year":"2017","journal-title":"J. Cranio-Maxillofacial Surg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1298","DOI":"10.1016\/j.ijom.2017.03.025","article-title":"A new approach of splint-less orthognathic surgery using a personalized orthognathic surgical guide system: A preliminary study","volume":"46","author":"Li","year":"2017","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1016\/j.bjoms.2016.07.007","article-title":"Splintless surgery: Does patient-specific CAD-CAM osteosynthesis improve accuracy of Le Fort I osteotomy?","volume":"54","author":"Kraeima","year":"2016","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1016\/j.ijom.2019.08.022","article-title":"Splintless orthognathic surgery in edentulous patients\u2014A pilot","volume":"49","author":"Ho","year":"2019","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e41","DOI":"10.1016\/j.tripleo.2008.10.022","article-title":"The accuracy of image guided surgery based on cone beam computer tomography image data","volume":"107","author":"Eggers","year":"2009","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.jsmc.2018.10.013","article-title":"The Role of the Revised Stanford Protocol in Today\u2019s Precision Medicine","volume":"14","author":"Liu","year":"2019","journal-title":"Sleep Med. Clin."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1016\/j.joms.2014.08.006","article-title":"Improved apnea-hypopnea index and lowest oxygen saturation after maxillomandibular advancement with or without counterclockwise rotation in patients with obstructive sleep apnea: A meta-analysis","volume":"73","author":"Knudsen","year":"2015","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"e488","DOI":"10.1097\/SCS.0000000000003761","article-title":"Change in Posterior Pharyngeal Space after Counterclockwise Rotational Orthognathic Surgery for Class II Dentofacial Deformity Diagnosed with Obstructive Sleep Apnea Based on Cephalometric Analysis","volume":"28","author":"Jeong","year":"2017","journal-title":"J. Craniofac. Surg."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1007\/s11325-017-1484-7","article-title":"Counterclockwise maxillomandibular advancement: A choice for Chinese patients with severe obstructive sleep apnea","volume":"21","author":"Wei","year":"2017","journal-title":"Sleep Breath."}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/13\/10\/1517\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:09:55Z","timestamp":1760130595000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/13\/10\/1517"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,22]]},"references-count":48,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2023,10]]}},"alternative-id":["jpm13101517"],"URL":"https:\/\/doi.org\/10.3390\/jpm13101517","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,22]]}}}