{
  "abstract": "Background A significant proportion of patients with OSA struggle to tolerate CPAP. Maxillo-mandibular advancement (MMA) represents an effective surgical intervention. However, current practice often employs standardized advancement protocols without consideration of individual anatomical requirements. This retrospective QIP evaluates outcomes from a personalized, millimetre-specific advancement strategy that tailors surgical intervention to individual patient rather than adopting a uniform approach.Methods We conducted a retrospective review of patients with moderate-to-severe OSA who underwent MMA between 2023–2025. All patients had documented CPAP intolerance or treatment failure. The surgical technique involved mandibular osteotomy with initial distraction to 7 mm along with plate and screw insertion. Beginning on postoperative day 8, patients performed gradual mandibular advancement by turning distraction screws 1 mm incrementally. Follow-up sleep studies were conducted after each advancement, and patients with persistent OSA underwent further 1–2 mm advancements until therapeutic targets were achieved. Primary outcomes included surgical success rates (defined as postoperative AHI <5 events/hour or >50% reduction from baseline) and complete cure rates (AHI <5 events/hour). Secondary outcomes assessed improvement in subjective sleepiness using Epworth Sleepiness Scale (ESS).Results 11 patients (9 male, 2 female) with mean age 49 years and BMI 30.3±5.2 kg/m 2 underwent individualized MMA. Mean pre-operative AHI was 42.8/hour (range 16–110). Surgical advancement was personalized, ranging from 7 to 16 mm, (mean 11.9 mm). Post-operative AHI decreased to 6.3±5.3/hour (range 1.8–20), representing an 85% reduction. Surgical success was achieved in 10/11 patients (90.9%), with complete cure in 5/11 patients (45.5%). ESS scores improved from 14.1±5.4 to post-operative values to 5.55.5±4.3. Notably, patients receiving smaller advancements (≤10 mm) achieved 100% success rates, challenging assumptions that larger advancements necessarily yield superior outcomes.Conclusions Individualized approach to maxillomandibular advancement (MMA) demonstrates that personalized advancement strategies achieve excellent outcomes while potentially reducing surgical morbidity associated with excessive advancement. The wide range of effective advancement distances (7–16 mm) underscores the inadequacy of standardized protocols and supports the use of postoperative sleep studies to objectively guide patient-specific treatment, challenging the one-size-fits-all approach. These findings also highlight the importance of collaborative approach between sleep physicians and surgeons in optimizing patient outcomes.",
  "authors": [
    {
      "affiliations": [
        "Respiratory and Sleep Medicine Department, Nottingham University Hospitals NHS Trust, Nottingham, UK"
      ],
      "name": "MZ Nasim"
    },
    {
      "affiliations": [
        "Oral and Maxillofacial Surgery Department, Nottingham University Hospitals NHS Trust, Nottingham, UK"
      ],
      "name": "D Srinivasan"
    },
    {
      "affiliations": [
        "Respiratory and Sleep Medicine Department, Nottingham University Hospitals NHS Trust, Nottingham, UK"
      ],
      "name": "S Adlakha"
    },
    {
      "affiliations": [
        "Respiratory and Sleep Medicine Department, Nottingham University Hospitals NHS Trust, Nottingham, UK"
      ],
      "name": "R Singh"
    },
    {
      "affiliations": [
        "Oral and Maxillofacial Surgery Department, Nottingham University Hospitals NHS Trust, Nottingham, UK"
      ],
      "name": "J Jones"
    },
    {
      "affiliations": [
        "Respiratory and Sleep Medicine Department, Nottingham University Hospitals NHS Trust, Nottingham, UK"
      ],
      "name": "MP Sovani"
    }
  ],
  "title": "P55 Personalized maxillo-mandibular advancement in obstructive sleep apnoea: a millimetre-based individualized treatment approach",
  "uid": "c847830e-8597-5d6f-bcb0-8be9aedcf3e3"
}