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he two groups did not identify any significant benefit toerforming UPPP prior to MMA. Therefore, strong con-ideration should be given to performance of MMA ashe first or primary surgical procedure for patients withevere OSA. MMA performed alone would have the ad-itional important benefits of decreasing overall treat-ent time and exposing the patient to less surgical risk.

References

Prinsell JR. Maxillomandibular advancement surgery in a site specificreatment approach for obstructive sleep apnea in 50 consecutiveatients. Chest 1999; 116: 1519-1529Riley RW, Powell NB, Guilleminault C. Maxillary, mandibular, and

yoid advancement for treatment of obstructive sleep apnea. A reviewf 40 patients. J Oral Maxillofac Surg 1990; 48:20-26

hree-Dimensional Computedomographic Airway Analysis ofatients With Obstructive Sleep Apneareated by Maxillomandibulardvancementachary R. Abramson, BS, Boston, MA (Bouchard C;usarla S; Troulis MJ; Kaban LB)

Statement of the Problem: Using 3-dimensional CTata, it has been demonstrated that the presence ofbstructive sleep apnea (OSA) is associated with in-reased overall airway length relative to controls andhat severity of OSA is inversely related to lateral tonteroposterior dimension ratio (at retroglossal level).owever, there is little data documenting changes in

hese airway parameters following maxillomandibulardvancement (MMA). The purpose of this study is toocument changes in upper airway size and shape, fol-

owing MMA.Materials and Methods: This is a retrospective case

eries of patients with OSA treated at Massachusettseneral Hospital, Department of Oral and Maxillofacialurgery from March 2005 through January 2009. Patientsere included if: 1) the diagnosis of OSA was confirmedy overnight polysomnogram (PSG), 2) maxillomandibu-

ar advancement was performed and 3) pre and post-perative 3-D airway CT scans were available. All scansere imported into a CT analyzing computer software to

reate digital 3-D reconstructions of the airway. Param-ters of airway size [volume (VOL), surface area (SA),ength (L), mean cross-sectional area (mean CSA), mini-

um retropalatal (RP), minimum retroglossal (RG), min-mum cross-sectional area (min CSA), and lateral (LAT)nd anteroposterior (AP) retroglossal airway dimen-ions] were measured and analyzed. Evaluation of airwayhape included LAT/AP and RP/RG ratios, uniformityU), and sphericity, a measure of compactness (�). De-criptive statistics were computed for all variables. Prend post-operative airway data were analyzed using a

on-parametric paired samples test (Wilcoxon Signed- B

4

ank test). Pre and post-operative sleep and breathingelated symptoms (i.e. snoring, daytime somnolence,ttention deficit, fatigue) were recorded. For all analyses,-values � 0.05 were considered statistically significant.Methods of Data Analysis: [see above]Results: There were 44 OSA patients treated during

his period, of which 6 (M:F� 3:3, ages 13-51, mean 29)et the inclusion criteria. Indications for MMA included

evere OSA and intolerance of nasal Continuous Positiveirway Pressure (CPAP). The most common symptomeported preoperatively was daytime somnolence (n �), followed by snoring (n � 3), morning headachesn � 2) and falling asleep while driving (n � 2). Meanre-operative RDI and LSAT were 35.5 (range 16 to 51)nd 87 (range 73 to 93), respectively. Following MMA,ultiple airway parameters of size showed significant

ncreases including LAT (p � 0.028), VOL (p � 0.028),G (p � 0.046), RP (p � 0.028), min CSA (p � 0.028),vg CSA (p � 0.028), and SA (p � 0.028). Airway lengthas significantly decreased following MMA (p � 0.028).one of the parameters of airway shape were altered

ignificantly by MMA. Post-operatively, five of six pa-ients reported resolution of their symptoms and CPAPas discontinued. One patient, after initial improve-ent, developed chronic sinusitis, post-nasal drip, and

ustained a maxillary fracture from blunt trauma, is stillnder treatment.Conclusion: The results of this preliminary study

ndicate that MMA appears to produce significanthanges in airway size and shape that suggest a decreasen upper airway resistance. This study is ongoing andata will be updated as patients who meet the inclusionriteria are added.

References

Abramson ZR: Three-Dimensional CT Analysis of Airway Anatomy inatients With Obstructive Sleep Apnea. Educational Summaries andutlines - Scientific Sessions and Exhibition, AAOMS 90th Annualeeting. J Oral and Maxillofac Surg. Volume 66, Issue 8, Supplement 1,

August 2008) pg. 60Fairburn SC, Waite PD, Vilos G, et al: Three-dimensional changes in

pper airways of patients with obstructive sleep apnea followingaxillomandibular advancement. J Oral Maxillofac Surg. 2007 Jan;

5(1):6-12

This study was funded in part by the Hanson Foundation (Boston,A), The MGH Department of OMFS Education and Research Fund and

ynthes CMF, (West Chester, PA).

adiographic Changes Followingistraction Osteogenesis of the Maxilla

n Cleft Lip and Palate Patients Using aigid External Distractor

teven Fletcher, DDS, Iowa City, IA (Broadbent MW;

urton RG; Morgan TA)

AAOMS • 2009

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Statement of the Problem: Treatment of cleft lipnd palate requires a multi-disciplinary approach forptimal treatment and results. These patients often de-elop a retrusive, hypoplastic maxilla as a result of mul-iple surgical procedures. Their dentoskeletal discrep-ncy is often so great that it is difficult to treat withonventional orthognathic surgery. Following the prin-iples of distraction osteogenesis, the use of the Rigidxternal Distractor (RED) has been shown to be anffective method to achieve larger movements of theaxilla in both horizontal and vertical dimensions. The

tability of these movements over the long term is im-ortant to understand for adequate planning for the clefteam, especially with regards to surgical and orthodonticlanning. This study evaluated the outcomes of patientsho underwent a Le Fort I osteotomy with subsequentlacement of a RED device to correct their maxillaryeficiency.Materials and Methods: A retrospective chart re-

iew was used to identify all patients who had under-one maxillary distraction at the University of Iowa.atients who had a Le Fort I osteotomy followed by REDevice placement for treatment of cleft lip and palateere included. Patients who had undergone distraction

or non-cleft purposes or who had insufficent data oradiographs were excluded. Lateral cephalograms fromre-surgery, post-distraction and follow-ups were exam-

ned. Each patient was treated according to the samerotocol during surgery, postoperatively and throughoutetention. The radiographs were scanned into the Dol-hin Imaging 10.0 program with all radiographs beingcanned twice for reliability purposes. Cephalometricracings were then performed and a perpindicular linerom sella-nasion intersecting point A was marked. Thisine allowed for assessment of the horizontal movementt point A. A second line was made parallel to thereviously drawn line which intersected with point sellao determine vertical movement at point A. All measure-ents were then made to the nearest 0.5 mm. Measure-ents were then compared to determine the initialovement and relapse in both dimensions. A sample

-test was used to determine if a statistical differencexisted between the values. All tests had a 0.05 level oftatistical significance.

Methods of Data Analysis: n/aResults: Sixteen patients were identified who met the

nclusion criteria. They ranged in age from 10 to 16 yearsith a mean of 12.7 years at the time of surgery. Sevenatients had bilateral cleft lip and palate, five had a leftided cleft and four had a right sided cleft. There werewelve males and four females. The mean length ofollow-up was 28.6 months (range of 10 to 50) posturgery. Horizontal movements from presurgery to post-istraction showed a mean of 13.44 and 13.28 mm withminimum of 3 and 4 mm and a maximum of 31 and

0.5 mm with a standard deviation of 6.84 and 6.87 mm. a

AOMS • 2009

rom pre-surgery to retention there was a mean move-ent of 9.81 and 9.94 mm with a minimum of 2 and 1m and maximums of 19 and 18.5 mm with a standard

eviation of 5.33 and 5.42. From post-distraction to re-ention, a mean change of �3.5 mm and �3.47 mm wasound with a range from 5 and 5 mm forward to �17.5m and �17.5 mm. Standard deviation was 5.28 and

.36. Vertical movements from pre surgery to post-dis-raction showed a mean of 4.13 and 3.16 mm with aange of 4 and 4.5 mm impaction to 13 and 11.5 mmownward movement with a standard deviation of 4.75nd 4.65. From pre-surgery to retention there was aean vertical movement of 5.25 and 4.22 mm with a

ange of 3 and 4.5 mm impaction to 20 and 22.5 mmownward movement with a standard deviation of 6.07nd 6 mm. Post-distraction to retention comparison re-ealed a mean downward vertical movement of 1.13 and.06 mm with a range of 5 and 5 mm impaction toownward movement of 9.5 and 10 mm with a standardeviation of 4.05 and 4.19 mm.Conclusion: The results of this study suggest thathen using a RED device for movements greater than

0mm, a horizontal relapse of approximately 3.5 mmhould be anticipated. Vertical movements appear to betable, especially impactions. Downward movementsave an expected relapse of approximately 1 mm.

References

Wiltfang J, Hirshfelder U, Neukam FW, Kessler P. Long term resultsf distraction osteogenesis of the maxilla and midface. British Journalf Oral and Maxillofacial Surgery 2002;40:473-479Suzuki EY, Motohashi N, Ohyama K. Longitudinal dento-skeletal

hanges in UCLP patients following maxillary distraction osteogenesissing RED system. J Med Dent Sci 2004; 51:27-33

redictors of Velopharyngealncompetence in Cleft Patients Followinge Fort I Maxillary Advancementonnie L. Padwa, DMD, MD, Boston, MA (McCombW; Marrinan EM; Nuss R)

resented by: Ryan W. McComb, BA, Boston, MA

Statement of the Problem: Approximately 25-40%f cleft patients develop maxillary hypoplasia requiringe Fort I osteotomy. Maxillary advancement brings theoft palate forward and can lead to velopharyngeal insuf-ciency (VPI) and hypernasal speech. The goal of thistudy was to identify predictors that place cleft patientst risk of developing velopharyngeal incompetence aftereFort I maxillary advancement.Materials and Methods: This retrospective case-se-

ies study included non-syndromic cleft patients whoad Le Fort I osteotomy for correction of midface hy-oplasia at Children’s Hospital Boston between 1995

nd 2008. Patient charts were reviewed for gender, cleft

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