This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Viozzi, C. F. Search for Related Content PubMed PubMed Citation Articles by Viozzi, C. F.

---

LETTER TO THE EDITOR

Further Thoughts on Airway Management After Maxillomandibular Advancement for Obstructive Sleep Apnea

Mayo Clinic College of Medicine; Rochester, Minnesota; Viozzi.Christopher{at}mayo.edu

To the Editor:

Although we agree with the anesthetic management of patients undergoing maxillomandibular advancement as described by Hogan and Argalious (1), the surgical management described in the article is somewhat different with respect to the need for perioperative and postoperative "wiring" of the jaws and this clearly has an impact on the anesthetic/airway management as well. In our experience, the need to wire the jaws together is a very rare occurrence, and in the vast majority of these patients the trachea can be extubated safely in the operating room at the conclusion of surgery.

Our surgical approach to these patients involves a standard maxillary and mandibular osteotomy with advancement of the facial complex by 10–12 mm. Patients' jaws are only wired during the procedure to allow proper osseous segment positioning, but the jaws are not wired after the surgery is finished, thereby allowing mobility of the mandible at extubation in the operating room. We feel this is important, as it allows access to the airway in the operating room, and permitting immediate attempts at oral reintubation should the need arise. In addition, the use of intermaxillary fixation has not been shown to be of benefit for short-term or long-term skeletal stability (surgical outcome) (2,3).

Rarely, because of intraoperative difficulties with the bone cuts or application of fixation, it is necessary to truly wire the patient's jaws together for a period of several weeks to allow proper bone positioning, stability, and proper osseous healing. However, the placement of the wires or heavy elastics (rubber bands) can frequently be delayed until after extubation in the operating room without consequence.

Footnotes

Dr. Argalious does not wish to respond.

REFERENCES

1. Hogan PW, Argalious M. Total airway obstruction after maxillomandibular advancement surgery for obstructive sleep apnea. Anesth Analg 2006;103:1267–9[Abstract/Free Full Text]
2. Nimkarn Y, Miles PG, Waite PD. Maxillomandibular advancement surgery in obstructive sleep apnea syndrome patients: long-term surgical stability. J Oral Maxillofac Surg 1995;53:1414–8[Web of Science][Medline]
3. Louis PJ, Waite PD, Austin RB. Long-term skeletal stability after rigid fixation of Le Fort I osteotomies with advancements. Int J Oral Maxillofac Surg 1993;22:82–6[Web of Science][Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Viozzi, C. F. Search for Related Content PubMed PubMed Citation Articles by Viozzi, C. F.