The Effect of Maxillomandibular Advancement Surgeries on Eustachian Tube Dysfunction: A Retrospective Analysis

Introduction: Maxillomandibular advancement (MMA) surgeries are a cornerstone treatment for obstructive sleep apnea (OSA), aiming to expand the upper airway and improve airflow. However, a few studies have associated orthognathic surgeries with post-operative Eustachian tube dysfunction (ETD). This study investigates the impact of MMA surgeries on ETD to explore potential postoperative effects.

Methods: A retrospective review was conducted on patients who underwent MMA at a single academic institution. ETD severity was assessed preoperatively and postoperatively using a standardized scale (ETDQ-7). Descriptive statistics were used to analyze the demographic and clinical characteristics of the cohort, while paired and unpaired t-tests compared ETD scores and other patient-reported outcome measures (PROMs) pre- and post-surgery.

Results: The study included 21 patients (61.9% male, 38.1% female; mean age 49.9 ± 10.5 years). Patients reported a significant improvement in PROMs including EPS and NOSE post-operatively (p = 0.012 and p = 0.026 respectively). Preoperative ETD scores averaged 13.84 ± 8.67, compared to postoperative scores of 11.00 ± 6.31 (p > 0.05). No significant changes were observed in ETD severity following MMA. However, paired analysis on five patients who reported symptoms of ETD pre-operatively showed an overall significant improvement in symptoms post-MMA with a mean difference of 6.5 (p = 0.039). The findings suggest that MMA does not exacerbate ETD, but can rather improve subjective ETD symptoms in patients with pre-operative Eustachian Tube Dysfunction.

Conclusions: This study provides evidence that MMA surgeries for OSA do not negatively impact Eustachian tube function. These findings are relevant for preoperative counseling and postoperative management of patients undergoing MMA. Further research is warranted to validate these results in larger cohorts and investigate potential mechanisms underlying the observed outcomes.