Impact of nasal modifications on sinonasal function after maxillomandibular advancement for obstructive sleep apnea

Purpose To assess sinonasal function after preservation maxillomandibular advancement (MMA), as initial reports have shown it may decrease postoperatively. Methods This prospective study was performed at a tertiary referral center starting January 2023. MMA was performed with previously published nasal modifications to help mitigate negative sinonasal outcomes. Sino-nasal Outcome Test (SNOT-22) and Nasal Obstruction Symptom Evaluation Survey (NOSE) were collected preoperatively, and one and three months postoperatively. Repeated measures ANOVAs with a Bonferroni adjustment were performed for total score, total sinonasal score (sum of questions 1-12), and each symptom. Both p-values and partial eta squared (n(p)(2)) were reported. Results Twenty patients were included. Median age was 50.7 years (range 31-65), with 20.0% being female. Preoperative AHI (65.1 +/- 28.9) and SpO2 Nadir (78.0% [69.0-82.0]) improved to 12.1 +/- 12.1 and 86.0 +/- 3.2%. NOSE significantly decreased at one month (55.9 +/- 28.4 vs. 8.11 +/- 12.0, p < 0.001). Total score and total sinonasal scores significantly decreased postoperatively (49.0 +/- 21.6 vs. 18.1 +/- 17.4 vs. 12.5 +/- 14.1, p < 0.001; 17.3 +/- 12.5 vs. 9.2 +/- 9.3 vs. 6.3 +/- 7.3, p = 0.003) with MMA having large effects on both variables (n(p)(2)=0.72 and 0.35, respectively). MMA had large significant effects on improvement in need to blow nose, nasal blockage, sneezing, runny nose, cough, post-nasal discharge, dizziness, and ear pain at one and three months postoperatively. Facial pain/pressure significantly worsened at one-month but then improved to baseline at three months postoperatively ((1.2 +/- 1.4 vs. 1.9 +/- 1.5 vs. 1.2 +/- 1.4, p = 0.026). Conclusion Patients who underwent preservation MMA did not show evidence of worsening sinonasal function, with some evidence that sinonasal function may improve after MMA at three months postoperatively. Long-term follow-up with more patients is needed to support these findings.