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<p>Maxillomandibular advancement (MMA) is highly effective for obstructive sleep apnea (OSA) but may compromise facial aesthetics in East Asian patients due to bimaxillary protrusion. Two modifications address this: maxillary counterclockwise rotation with no segmental surgery (MaxCCWR) and maxillary anterior segmental osteotomy (MaxASO). A PRISMA 2020-compliant systematic review and meta-analysis was conducted (PROSPERO: CRD420261296073). PubMed, Embase, Web of Science, and Cochrane were searched to 5th February 2026. Studies reporting MMA for OSA in East or Southeast Asian adults with aesthetic outcomes were eligible. Random-effects proportion meta-analysis pooled the proportion of satisfied patients. Fourteen studies (n=167) were included. Most patients were skeletal Class II (mean age 34.49 ± 9.92 years; 73.7% male). The pooled proportion satisfied was 0.83 (95% CI [0.76; 0.87]; I<sup>2</sup>=0%), with no significant difference between MaxCCWR and MaxASO (0.82 vs 0.84; p=0.75). MaxCCWR proclines while MaxASO retroclines the maxillary incisors, reflecting divergent strategies toward the same aesthetic goal. AHI reduced from 52.17 ± 20.13 to 9.65 ± 7.32 events/h (pooled mean change −44.0 events/h, 95% CI [−51.8, −36.3]); the between-group difference was not significant (p=0.99). Improvements in lowest oxygen saturation and Epworth Sleepiness Scale scores were comparable between modifications (p=0.35 and p=0.30, respectively). Both MaxCCWR and MaxASO mitigate aesthetic concerns while achieving substantial OSA improvement in East Asian patients.</p>

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Satisfaction with facial appearance after maxillomandibular advancement in East Asian Patients - a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月27日

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  • Chee Weng Yong,
  • Ker Jia Cheryl Lee,
  • Wei Ming Clement Lai,
  • Crystal Shuk Jin Cheong,
  • Raymond Chung Wen Wong,
  • Tong Xi

摘要

Maxillomandibular advancement (MMA) is highly effective for obstructive sleep apnea (OSA) but may compromise facial aesthetics in East Asian patients due to bimaxillary protrusion. Two modifications address this: maxillary counterclockwise rotation with no segmental surgery (MaxCCWR) and maxillary anterior segmental osteotomy (MaxASO). A PRISMA 2020-compliant systematic review and meta-analysis was conducted (PROSPERO: CRD420261296073). PubMed, Embase, Web of Science, and Cochrane were searched to 5th February 2026. Studies reporting MMA for OSA in East or Southeast Asian adults with aesthetic outcomes were eligible. Random-effects proportion meta-analysis pooled the proportion of satisfied patients. Fourteen studies (n=167) were included. Most patients were skeletal Class II (mean age 34.49 ± 9.92 years; 73.7% male). The pooled proportion satisfied was 0.83 (95% CI [0.76; 0.87]; I2=0%), with no significant difference between MaxCCWR and MaxASO (0.82 vs 0.84; p=0.75). MaxCCWR proclines while MaxASO retroclines the maxillary incisors, reflecting divergent strategies toward the same aesthetic goal. AHI reduced from 52.17 ± 20.13 to 9.65 ± 7.32 events/h (pooled mean change −44.0 events/h, 95% CI [−51.8, −36.3]); the between-group difference was not significant (p=0.99). Improvements in lowest oxygen saturation and Epworth Sleepiness Scale scores were comparable between modifications (p=0.35 and p=0.30, respectively). Both MaxCCWR and MaxASO mitigate aesthetic concerns while achieving substantial OSA improvement in East Asian patients.