I’m writing to express concern regarding the lack of orthodontic information when the Journal ventures into the subject of obstructive sleep apnea (OSA). The September issue contained another example of this in its Clinician’s Corner article (Schendel SA, Broujerdi JA, Jacobson RL. Three-dimensional upper-airway changes with maxillomandibular advancement for obstructive sleep apnea treatment. Am J Orthod Dentofacial Orthop 2014;146:385-93). The authors presented the case for maxillomandibular advancement (MMA) as a “definitive correction of the problem.” They “describe in a comprehensive and systematic fashion the evaluation of the upper airway of OSA patients before and after MMA surgery.” What this and other articles fail to describe are the orthodontic results! This article may be more appropriate in the peer-reviewed publications of our ENT friends and colleagues. No attempt was made to characterize the orthodontic outcomes, even though it was stated that “the patients were in preoperative orthodontic treatment initially for an average of 6 months.” We should be able to assume then that adequate pretreatment records were taken. Could the reason for the lack of reporting be the poor orthodontic outcomes?
How can an article in this Journal claim to be a comprehensive evaluation without reporting the pretreatment and posttreatment orthodontic conditions? How can there be no discussion of the degree of hard-tissue relapse that is expected when we place the “oropharyngeal musculature on tension” (reporting a 9.4-mm mean maxillary and a 9.5-mm mean mandibular movement)? Can the authors explain the use of imagery in Figure 1, given the clear inconsistency in tongue position? The orthodontic impressions one might take from these images do not seem favorable.
Recently, one of our more respected orthodontic authorities presented an MMA case for our constituent meeting. When asked why the orthodontic goals seemed more compromised in these patients, he correctly indicated the priority given to OSA morbidity but avoided any discussion of the orthodontic outcome.
It is time to ask for more transparency regarding the orthodontic outcomes of the various OSA treatment modalities. As members of the treatment team, are we not responsible for providing a basis for informed consent regarding the stomatognathic system? Given the current state of the literature, this is not yet possible, and to neglect this responsibility is a disservice to our patients.