Splintless Versus Conventional Maxillomandibular Advancement Surgery for Obstructive Sleep Apnea (SvCMAS)
13 maj 2026 uppdaterad av: Prof. dr. J. de Lange, MD DMD, Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)
Splintless Versus Conventional Maxillomandibular Advancement Surgery for Obstructive Sleep Apnea: a Randomized Controlled Trial
The goal of this clinical trial is to find out whether using a splintless surgical approach improves the accuracy of maxillomandibular advancement (MMA) surgery for treating obstructive sleep apnea (OSA) in adults. The study will also look at the safety, functional outcomes, and cost-effectiveness of the splintless approach. The main questions it aims to answer are:
Does the splintless approach lead to more accurate surgical movements of the jaws compared to the conventional splint-based method? What are the safety profile, functional outcomes, and cost-effectiveness of the splintless approach?
Researchers will compare splintless MMA to conventional MMA.
Patients will:
Undergo MMA surgery using either the splintless or splint-based method; Attend regular follow-up visits as part of routine care; Complete questionnaires and undergo assessments at various time points; Receive one additional CT scan (24 months after surgery) and one overnight sleep study (60 months after surgery).
Bedpartners of patients will:
Complete questionnaires at various time points.
This trial will help determine whether the splintless approach is a better, safer, and more effective alternative for treating OSA with MMA surgery.
Studieöversikt
Status
Har inte rekryterat ännu
Intervention / Behandling
Studietyp
Interventionell
Inskrivning (Beräknad)
66
Fas
- Inte tillämpbar
Kontakter och platser
Det här avsnittet innehåller kontaktuppgifter för dem som genomför studien och information om var denna studie genomförs.
Studiekontakt
- Namn: Ho
- Telefonnummer: 020-5663898
- E-post: j.p.ho@amsterdamumc.nl
Studieorter
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North Holland
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Amsterdam, North Holland, Nederländerna, 1105 AZ
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC
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Kontakt:
- Ho
- Telefonnummer: 020-5663898
- E-post: j.p.ho@amsterdamumc.nl
-
-
Deltagandekriterier
Forskare letar efter personer som passar en viss beskrivning, så kallade behörighetskriterier. Några exempel på dessa kriterier är en persons allmänna hälsotillstånd eller tidigare behandlingar.
Urvalskriterier
Åldrar som är berättigade till studier
- Vuxen
- Äldre vuxen
Tar emot friska volontärer
Nej
Beskrivning
Inclusion Criteria:
For OSA patients:
- Adults aged 18 years or older;
- Moderate to severe OSA (apnea hypopnea index (AHI) ≥ 15 events/hour) as determined by an overnight polysomnography (PSG) preoperatively;
- Continunous positive airway pressure failure or intolerance;
- General good health for surgery;
- MMA surgery indicated for OSA treatment.
For bedpartners of patients:
• Sharing a bed ⩾2 nights/week with patient.
Exclusion Criteria:
For OSA patients:
- Other adjunctive procedures indicated at the time of MMA (e.g., multi-piece Le Fort I osteotomy, temporomandibular joint reconstruction);
- Previous history of orthognathic surgery;
- Cleft palate and syndromic patients;
- Refusal to participate.
For bedpartners of patients:
• Refusal to participate.
Studieplan
Det här avsnittet ger detaljer om studieplanen, inklusive hur studien är utformad och vad studien mäter.
Hur är studien utformad?
Designdetaljer
- Primärt syfte: Behandling
- Tilldelning: Randomiserad
- Interventionsmodell: Parallellt uppdrag
- Maskning: Enda
Vapen och interventioner
Deltagargrupp / Arm |
Intervention / Behandling |
|---|---|
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Experimentell: Splintless group
In the splintless group, MMA using patient-specific osteotomy guides and fixation implants (i.e., splintless MMA) will be executed.
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Splintless orthognathic surgery is a more recent technical innovation in Oral and Maxillofacial surgery, in which patient-specific computer-aided design and manufacturing (CAD/CAM) surgical cutting guides and fixation implants are used to improve surgical precision.
Splintless MMA sugery involves virtual surgical planning, surgical procedures, and postoperative monitoring.
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Aktiv komparator: Splint group
In the splint group, conventioanl MMA using surgical splints (i.e., splint MMA) will be executed.
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In splint MMA surgery, surgical procedure is virtually planned in three dimensions (3D) and the surgical planning is transfered to the operating room with 3D-printed intermediate and final splints.
These splints are used during surgery to place and fixate the maxilla and mandible in the planned position.
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Vad mäter studien?
Primära resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
|---|---|---|
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Surgical accuracy
Tidsram: 1 week after MMA
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Because the main objective of MMA for OSA is achieving the planned advancement and counter-clockwise rotation to relieve the upper airway collapse, anteroposterior translation of the maxilla and mandible, and pitch of the maxilla and mandible are the main study parameters. The postoperative CT scan is superimposed on the preoperative virtual planning. The absolute difference between the planned value for a parameter and the postoperative acquired value will be calculated, which provides an intuitive accuracy measurement of MMA surgery. |
1 week after MMA
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Sekundära resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
|---|---|---|
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Other translational surgical movement parameters
Tidsram: 1 week after MMA
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Mediolateral and superoinferior movement of the maxilla and mandible in millimeters measured by CT scan
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1 week after MMA
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Other rotational surgical movement parameters
Tidsram: 1 week after MMA
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Roll and yaw of the maxilla and mandible in degrees measured by CT scan
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1 week after MMA
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Duration of surgery
Tidsram: During MMA surgery
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The time between the start of incision and the suture of the incisions.
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During MMA surgery
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Blood loss
Tidsram: During MMA surgery
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Blood loss during surgery
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During MMA surgery
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Adverse events/complications
Tidsram: During MMA surgery and follow-Ups (up to 60 months postoperatively)
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Intra- and post-operative adverse events/complications
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During MMA surgery and follow-Ups (up to 60 months postoperatively)
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Apnea hypopnea index
Tidsram: Preoperatively, six months postoperatively, and 60 months postoperatively
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The average number of apnea and hypopnea events per hour of sleep during a sleep study (polysomnography)
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Preoperatively, six months postoperatively, and 60 months postoperatively
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3% oxygen desaturation index
Tidsram: Preoperatively, six months postoperatively, and 60 months postoperatively
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Number of times per hour of sleep that blood oxygen saturation drops by ≥3% from baseline during a sleep study
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Preoperatively, six months postoperatively, and 60 months postoperatively
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Lowest oxygen saturation
Tidsram: Preoperatively, six months postoperatively, and 60 months postoperatively
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The minimum blood oxygen level (%) reached during a sleep study
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Preoperatively, six months postoperatively, and 60 months postoperatively
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Percentage of sleep time spent with oxygen saturation < 90%
Tidsram: Preoperatively, six months postoperatively, and 60 months postoperatively
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Percentage of sleep time spent with blood oxygen saturation < 90% during a sleep study
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Preoperatively, six months postoperatively, and 60 months postoperatively
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Epworth sleep scale (ESS) total score
Tidsram: Preoperatively, and 3 months, 6 months, 12 months, 24 months, 36 months, 48 months, and 60 months after MMA
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Daytime sleepiness as assessed with Epworth sleep scale total score (range 0-24; higher scores indicate greater daytime sleepiness / worse outcome)
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Preoperatively, and 3 months, 6 months, 12 months, 24 months, 36 months, 48 months, and 60 months after MMA
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Functional Outcomes of Sleep Questionnaire (FOSQ) total score
Tidsram: Preoperatively, and 3 months, 6 months, 12 months, 24 months, 36 months, 48 months, and 60 months after MMA
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Functional status as assessed with Functional Outcomes of Sleep Questionnaire total score (range 5-20; higher scores indicate better functional status / less impairment due to sleepiness)
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Preoperatively, and 3 months, 6 months, 12 months, 24 months, 36 months, 48 months, and 60 months after MMA
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Pittsburgh Sleep Quality Index (PSQI) global score
Tidsram: Preoperatively, and 3 months, 6 months, 12 months, 24 months, 36 months, 48 months, and 60 months after MMA
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Sleep quality as assessed with Pittsburgh Sleep Quality Index global score (range 0-21; higher scores indicate worse sleep quality)
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Preoperatively, and 3 months, 6 months, 12 months, 24 months, 36 months, 48 months, and 60 months after MMA
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EuroQol 5-Dimension 5-Level (EQ-5D-5L) utility index
Tidsram: Preoperatively, and 3 months, 6 months, 12 months, 24 months, 36 months, 48 months, and 60 months after MMA
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Patient's health status as assessed with EuroQol 5-Dimension 5-Level utility index (utility index ranges from <0 to 1; higher scores indicate better health-related quality of life)
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Preoperatively, and 3 months, 6 months, 12 months, 24 months, 36 months, 48 months, and 60 months after MMA
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EuroQol 5-Dimension 5-Level (EQ-5D-5L) visual analogue scale (VAS) score
Tidsram: Preoperatively, and 3 months, 6 months, 12 months, 24 months, 36 months, 48 months, and 60 months after MMA
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Patient's health status as assessed with EuroQol 5-Dimension 5-Level visual analogue scale (VAS) score (VAS ranges 0-100, higher scores indicate better health status)
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Preoperatively, and 3 months, 6 months, 12 months, 24 months, 36 months, 48 months, and 60 months after MMA
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36-Item Short Form Health Survey (SF-36) domain and summary scores
Tidsram: Preoperatively, and 3 months, 6 months, 12 months, 24 months, 36 months, 48 months, and 60 months after MMA
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Quality of life as assessed with 36-Item Short Form Health Survey domain and summary scores (range 0-100; higher scores indicate better health-related quality of life)
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Preoperatively, and 3 months, 6 months, 12 months, 24 months, 36 months, 48 months, and 60 months after MMA
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FACE-Q satisfaction with facial appearance score
Tidsram: Preoperatively, and 3 months, 6 months, 12 months, 24 months, 36 months, 48 months, and 60 months after MMA
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Patient satisfaction with facial appearance as assessed using the FACE-Q questionnaire (range 0-100; higher scores indicate greater satisfaction with facial appearance / better outcome)
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Preoperatively, and 3 months, 6 months, 12 months, 24 months, 36 months, 48 months, and 60 months after MMA
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Patient satisfaction with facial appearance and surgical outcome
Tidsram: Preoperatively, and 3 months, 6 months, 12 months, 24 months, 36 months, 48 months, and 60 months after MMA
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Patient's satisfaction with surgery outcomes as assessed with customized patient satisfaction questionnaire (5-point Likert scales; higher ratings indicate greater satisfaction)
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Preoperatively, and 3 months, 6 months, 12 months, 24 months, 36 months, 48 months, and 60 months after MMA
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Partner-reported snoring severity, snoring disturbance, and satisfaction with postoperative facial appearance (5- to 6-point Likert scales）
Tidsram: Preoperatively and 6 months after MMA
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Partner-reported assessment of snoring severity, snoring-related disturbance, and perceived postoperative facial appearance changes using a study-specific questionnaire completed by the participant's partner (higher ratings indicate greater snoring severity/disturbance or more positive perceived facial change, depending on the item).
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Preoperatively and 6 months after MMA
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Postsurgical relapse measures
Tidsram: 2 years after MMA
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Postsurgical relapse measures in translation parameters (anteroposterior, mediolateral, superoinferior) and rotation parameters (roll, pitch, yaw) of the maxilla and mandible.
The discrepancy between immediately post-operation (1 week after MMA) and 2 years after surgery will be used to define the amount of relapse.
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2 years after MMA
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Facial soft tissue changes
Tidsram: 6 months after MMA
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Facial soft tissue changes following MMA at various soft-tissue points.
These are determined by the difference in 3D coordinates of soft tissue landmarks between baseline and 6 months after MMA;
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6 months after MMA
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Upper airway volume
Tidsram: Preoperatively and 6 months after MMA
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Upper airway volume (mm³) measured using three-dimensional imaging analysis
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Preoperatively and 6 months after MMA
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Upper airway length
Tidsram: Preoperatively and 6 months after MMA
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Upper airway length measured using three-dimensional imaging analysis (mm)
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Preoperatively and 6 months after MMA
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Upper airway surface area
Tidsram: Preoperatively and 6 months after MMA
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Upper airway surface area (mm²) measured using three-dimensional imaging analysis
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Preoperatively and 6 months after MMA
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Upper airway minimum cross-sectional area (minCSA)
Tidsram: Preoperatively and 6 months after MMA
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Minimum cross-sectional area (mm²) of the upper airway measured using three-dimensional imaging analysis
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Preoperatively and 6 months after MMA
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Lateral dimension of the minimum cross-sectional area of the upper airway
Tidsram: Preoperatively and 6 months after MMA
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Lateral dimension of the upper airway minimum cross-sectional area (mm) measured using three-dimensional imaging analysis.
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Preoperatively and 6 months after MMA
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Anteroposterior dimension of the minimum cross-sectional area of the upper airway
Tidsram: Preoperatively and 6 months after MMA
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Anteroposterior dimension of the upper airway minimum cross-sectional area (mm) measured using three-dimensional imaging analysis.
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Preoperatively and 6 months after MMA
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Blood pressure
Tidsram: Preoperatively, and 3 months, 6 months, 12 months, 24 months, 36 months, 48 months, and 60 months after MMA
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Systolic and diastolic blood pressure
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Preoperatively, and 3 months, 6 months, 12 months, 24 months, 36 months, 48 months, and 60 months after MMA
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Cost-effectiveness
Tidsram: 6, 12, 24, 36, 48, and 60 months after MMA
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Incremental cost-effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR).
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6, 12, 24, 36, 48, and 60 months after MMA
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Samarbetspartners
Studieavstämningsdatum
Dessa datum spårar framstegen för inlämningar av studieposter och sammanfattande resultat till ClinicalTrials.gov. Studieposter och rapporterade resultat granskas av National Library of Medicine (NLM) för att säkerställa att de uppfyller specifika kvalitetskontrollstandarder innan de publiceras på den offentliga webbplatsen.
Studera stora datum
Studiestart (Beräknad)
1 december 2026
Primärt slutförande (Beräknad)
30 juni 2028
Avslutad studie (Beräknad)
28 februari 2033
Studieregistreringsdatum
Först inskickad
6 maj 2026
Först inskickad som uppfyllde QC-kriterierna
13 maj 2026
Första postat (Faktisk)
20 maj 2026
Uppdateringar av studier
Senaste uppdatering publicerad (Faktisk)
20 maj 2026
Senaste inskickade uppdateringen som uppfyllde QC-kriterierna
13 maj 2026
Senast verifierad
1 maj 2026
Mer information
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Nyckelord
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Andra studie-ID-nummer
- 2024.0736
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