Impact of Nasal Modifications on Sinonasal Function After Maxillomandibular Advancement for Obstructive Sleep Apnea

Introduction: Maxillomandibular advancement (MMA) is an effective procedure in patients with severe obstructive sleep apnea (OSA); however, postoperative sinonasal function is currently understudied.

Methods: A prospective study at a tertiary referral center was performed starting January 2023, analyzing patients who underwent MMA with sinonasal modifications. The SNOT-22 was collected preoperatively, one, three, six, and twelve months postoperatively. Paired t-tests and one-way ANOVA with repeated measures with Bonferroni correction were performed for total score, total sinonasal score (sum of questions 1-12), and each symptom.

Results: Forty-four patients were included. The median age was 50.5 years (range 20-68), and 27.3% were female. Preoperative total and total sinonasal scores were significantly reduced at all time points. Nasal blockage and cough were also significantly reduced at all time points. Need to blow nose and ear pain significantly decreased by three months and was persistently reduced at twelve months. Post-nasal drip and dizziness significantly improved at one, three, and six months but not significantly improved at twelve months. Sneezing, runny nose, thick nasal discharge, ear fullness, and decreased sense of smell initially improved at one or three months but was not significantly decreased at twelve months. Facial pain/pressure did not worsen at any time point.

Conclusions: Patients who underwent MMA with nasal modifications showed improvement in need to blow nose, nasal blockage, cough, and ear pain at one year postoperatively. No sinonasal symptoms worsened at any time, suggesting sinonasal function may be at least preserved in patients after MMA. Further long-term follow-up is needed to support these findings.