Satisfaction With Facial Aesthetic Appearance Following Maxillomandibular Advancement (MMA) for Obstructive Sleep Apnea (OSA): A Meta-Analysis

Abstract

Purpose: A large cohort of patients diagnosed with obstructive sleep apnea (OSA) require surgical intervention, sometimes in the form of maxillomandibular advancement (MMA), to correct their functional disturbance. Such a surgical procedure typically results in a slight modification of the patients' facial appearance. The purpose of the current systematic review and meta-analysis was to examine the rate of satisfaction with facial aesthetics post-MMA intervention and to assess its dependability on and relationship with other patient or treatment factors. Based on the literature currently available, and to the best of our knowledge, this is the first paper to draw on the topic analytically.

Methods: A search was conducted on four electronic literature databases (Pubmed, Ovid, Science Direct, and Scholar). Using referred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), our inclusion criterion covered any case with adequate reported data pertaining to the research question up to June 2021. Three evaluator groups were utilized. Satisfaction was defined as either an obvious reported increase in fondness for facial appearance or a state of indifference to the cosmetic results of the conducted changes. Dissatisfaction was defined as a clear discontent with the post-operative esthetic results. A multivariate analysis of the data was conducted, and Chi-square tests for independence were used to detect any significant associations. A meta-analysis of proportion was employed to permit for Freeman-Tukey double arcsine transformation and stabilize the variance of each study's proportion. Cochran's Q was computed, and the significance level was gauged as a function of P value.

Results: Meta-analyses of proportion conducted for assessment of aesthetic appraisal following surgical MMA for OSA elucidated a significantly higher predilection towards aesthetic satisfaction after surgical MMA for OSA for all evaluator groups in the encompassed studies. 94.2% of patients were satisfied with their facial esthetics postoperatively.

Conclusion: The vast majority of patients that undergo MMA for the correction of OSA report satisfaction with post-surgical facial aesthetics. The subjective assessment of this parameter by physicians and laypeople portrays an equivalently significant skew toward post-surgical appearance improvement. MMA is a generally safe procedure that substantially contributes to enhancement of both overall quality of life and perceived aesthetic appeal.

Keywords: airway obstruction; facial esthethic surgery; jaw corrrction surgeries; obstructive sleep apnea (osa); satisfaction rates.

Figure 1. Prisma Flowchart

Preferred reporting items for systematic reviews and meta-analysis (PRISMA) flowchart

Figure 2. Mean ages

Graphical representation of the patients’ mean ages across the included studies

Figure 3. Additional surgical procedures

Venn diagram illustrating the additional surgical procedures undergone by patients either prior to or concomitantly with MMA. *Data for patients with reported esthetic satisfaction only* MMA: Maxillomandibular Advancement

Figure 4. Aesthetic satisfaction scores

Stacked bar chart illustrating satisfaction of all three evaluator groups with post-MMA facial esthetic results

Figure 5. Meta-analysis of proportion for satisfaction (patient satisfaction)

Meta-analysis of proportion for satisfaction and 95% confidence interval (CI) by surgical outcomes as evaluated by subjective patient assessments, with relevant heterogeneity testing values.

Figure 6. Meta-analysis of proportion for satisfaction (physician satisfaction)

Meta-analysis of proportion for satisfaction and 95% confidence interval (CI) by surgical outcomes as evaluated by physician assessments, with relevant heterogeneity testing values

Figure 7. Meta-analysis of proportion for satisfaction (laypeople satisfaction)

Meta-analysis of proportion for satisfaction and 95% confidence interval (CI) by surgical outcomes as evaluated by laypeople assessments, with relevant heterogeneity testing values.