Virtual surgical planning improves surgical outcome measures in obstructive sleep apnea surgery


  • Jose E. Barrera MD, FACS, Lt Col, USAF, MC

    Corresponding author
    1. Division of Sleep Surgery and Facial Plastic Surgery, Department of Otolaryngology, San Antonio Military Medical Center, Fort Sam Houston, Texas, U.S.A.
    • Send correspondence to Jose E. Barrera, MD, Department of Otolaryngology, San Antonio Military Medical Center, 3851 Roger Brooke Drive, Ft. Sam Houston, TX 78234-6200. E-mail:

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  • The author has no funding, financial relationships, or conflicts of interest to disclose.



Determine the feasibility and accuracy of using virtual surgical planning (VSP) to direct the surgical and polysomnography (PSG) outcomes of patients with obstructive sleep apnea (OSA).

Study Design

Prospective case series.


Skeletal and soft tissue dimensions were measured from computed tomography (CT) to include posterior airway space (PAS) diameters at the occlusal (PAS-O) and mandibular (PAS-M) plane, position of the maxilla, and tooth-to-lip distance. All patients underwent an in-lab attended PSG whereby apnea-hypopnea index (AHI), respiratory disturbance index (RDI), and lowest oxyhemoglobin saturation percent (LSAT) were measured preoperatively and at least 9 months postoperatively.


Four patients with OSA demonstrated a mean AHI and RDI of 60.1 and 69.5 events per hour, respectively. The mean preoperative LSAT was 76%. Mean CT-based measures for PAS-O and PAS-M were 3.08 mm and 9.03 mm, respectively. VSP was used to direct the amount of advancement and impaction in maxillomandibular advancement (MMA) surgery. The mean PAS-O and PAS-M postoperative measures significantly increased to 8.15 and 14 mm (P < .004), whereas the mean tooth-to-lip relationship stayed the same, 3.17 to 3.18, P = .98. The AHI and RDI significantly improved to 2.83 and 4.5 events per hour, respectively, P = .03, whereas the LSAT improved from 76% to 87%.


VSP for MMA in OSA patients is feasible and safe while offering improvements in the predictability of airway change and tooth-to-lip measures.

Level of Evidence

NA Laryngoscope, 124:1259–1266, 2014