Background: To explore the feasibility, the efficacy, and the mechanism of mandibular advancement devices\n(MAD) in the treatment of persistent sleep apnea after surgery.\nMethods: Nineteen patients who failed uvulopalatopharyngoplasty (UPPP) or UPPP plus genioglossus advancement and\nhyoid myotomy (GAHM) were given a non-adjustable MAD for treatment. All patients had polysomnography (PSG) at\nleast 6 months post-UPPP with and without the MAD. Seventeen patients had computed tomography (CT) examinations.\nResults: After the application of MAD, the apnea hypopnea index (AHI) decreased significantly from 41.2 Ã?± 13.1/h to 10.\n1 Ã?± 5.6/h in the responder group. The response rate was 57.9% (11/19). During sleep apnea/hypopnea acquired from\nsedated sleep, the cross-sectional area and anterior-posterior and lateral diameters of the velopharynx enlarged\nsignificantly from 4.2 Ã?± 6.0 mm2 to 17.5 Ã?± 15.3 mm2, 1.9 Ã?± 2.3 mm to 6.5 Ã?± 4.1 mm, and 1.1 Ã?± 1.3 mm to 2.6 Ã?± 2.1 mm,\nrespectively (P < 0.01) in the responder group with MAD. The velopharyngeal collapsibility also decreased significantly\nfrom 83.3 Ã?± 21.8% to 46.5 Ã?± 27.1%. The glossopharyngeal collapsibility decreased from 39.8 Ã?± 39.1% to âË?â??22.9 Ã?± 73.2% (P\n< 0.05).\nConclusion: MAD can be an effective alternative treatment for patients with moderate and severe OSAHS after\nsurgery. The principal mechanisms underlying the effect of MAD are expansion of the lateral diameter of the\nvelopharynx, the enlargement of the velopharyngeal area, the reduction of velopharyngeal and glossopharyngeal\ncollapsibility, and the stabilization of the upper airway.
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