In more complex cases, the bones of the upper and lower jaw may be repositioned to increase the size of the airway (Orthognathic Surgery). It may be referred to as Maxillomandibular advancement (MMA). This procedure is done in the hospital under general anesthesia and requires 1 to 2 days overnight stay in the hospital. It is an orthognathic surgical procedure that has been proven to manage OSA in patients who are non-compliant or cannot tolerate CPAP or oral appliance therapy.
MMA is a site-specific procedure with the purpose of creating an enlarged posterior airway space at multiple anatomic levels, including the naso-pharynx, oropharynx and hypopharynx.
MMA has been shown to significantly improve OSA with success rates as high as 100%.
In 3 studies including a total number of 214 patients who had MMA the success rate was 96%.
Jaw advancement surgery is very well tolerated and can have significant benefits in improving the airway. Excellent long term (5 year) results have been documented with improvement in quality of life after MMA.
- Li KK: Surgical Therapy for the adult obstructive sleep apnea. Sleep Med Rev 9:201, 2005
- Prinsell JR: Maxillomandibular advancement in a site – specific approach for obstructive sleep apnea in 50 consecutive patients
- Riley RW, Powell NB, Builleminualt C: Obstructive sleep apnea syndrome: A review of 306 consecutively treated surgical patients. Otolaryngol Head Neck Surg 108: 117, 1993
Most patients benefit from multi-modality and multi-level (nose, palate, tongue, jaw) surgery.
Dr. Gilbert performs a comprehensive analysis prior to any treatment recommendations. We perform multi-level surgery as a single procedure for most patients that are refractory to conservative treatment attempts.
OSA is a very serious condition that needs careful attention and treatment. Most major medical plans offer coverage for diagnosis and treatment.
Maxillomandibular Advancement (MMA) – Corrective Jaw Surgery for OSA
MMA is a procedure that moves the upper and lower jaws to create a larger airway. Utilizing minimally invasive techniques the jaws can be advanced while the soft tissues of the tongue and palate are also moved forward, opening the entire airway. This procedure provides better breathing and a cure for moderate to severe sleep apnea.
Li et al concluded, “MMA is the most effective procedure for OSA.”
The MMA procedure may be a last resort for many patients. In such cases, it may represent the only technique that can create the necessary air passage to resolve OSA symptoms.
Li KK: Surgical Therapy for the adult obstructive sleep apnea. Sleep Med Rev 9:201, 2005