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Customised mandibular advancement splint for apnoeic patients undergoing maxillomandibular advancement

      Mandibular advancement splints are an effective treatment for patients with obstructive sleep apnoea,
      • Johnston C.D.
      • Gleadhill I.C.
      • Cinnamond M.J.
      • Gabbey J.
      • Burden D.J.
      Mandibular advancement appliances and obstructive sleep apnoea: a randomized clinical trial.
      and prospective studies have reported their use to be comparable to the gold standard of continuous positive airway pressure.
      • Tan Y.K.
      • L’Estrange P.R.
      • Luo Y.M.
      • Smith C.
      • Grant H.R.
      • Simonds A.K.
      • et al.
      Mandibular advancement splints and continuous positive airway pressure in patients with obstructive sleep apnoea: a randomized cross-over trial.
      However, both these treatments address only the symptoms, and patients often request a solution that avoids long-term dependence on either method. Recent evidence suggests that surgical advancement of the maxillary and mandibular bases is effective, and is associated with few complications.
      • Holty J.E.
      • Guilleminault C.
      Maxillomandibular advancement for the treatment of obstructive sleep apnea: a systematic review and meta-analysis.
      A positive response to the use of splints has been reported to predict cases that would be amenable to future maxillomandibular advancement.
      • Hoekema A.
      • de Lange J.
      • Stegenga B.
      • de Bont L.G.
      Oral appliances and maxillomandibular advancement surgery: an alternative treatment protocol for the obstructive sleep apnea–hypopnea syndrome.
      The treatment involves use of orthodontic appliances to prepare the patient before operation, but placement of a fixed appliance can compromise use of a splint during the pre-surgical orthodontic phase, and can result in symptoms returning and worsening.

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      References

        • Johnston C.D.
        • Gleadhill I.C.
        • Cinnamond M.J.
        • Gabbey J.
        • Burden D.J.
        Mandibular advancement appliances and obstructive sleep apnoea: a randomized clinical trial.
        European Journal of Orthodontics. 2002; 24: 251-262
        • Tan Y.K.
        • L’Estrange P.R.
        • Luo Y.M.
        • Smith C.
        • Grant H.R.
        • Simonds A.K.
        • et al.
        Mandibular advancement splints and continuous positive airway pressure in patients with obstructive sleep apnoea: a randomized cross-over trial.
        European Journal of Orthodontics. 2002; 24: 239-249
        • Holty J.E.
        • Guilleminault C.
        Maxillomandibular advancement for the treatment of obstructive sleep apnea: a systematic review and meta-analysis.
        Sleep Medicine Reviews. 2010; 14: 287-297
        • Hoekema A.
        • de Lange J.
        • Stegenga B.
        • de Bont L.G.
        Oral appliances and maxillomandibular advancement surgery: an alternative treatment protocol for the obstructive sleep apnea–hypopnea syndrome.
        Journal of Oral and Maxillofacial Surgery. 2006; 64: 886-891