Maxillomandibular Advancement in the Surgical Treatment of Obstructive Sleep Apnea

Several techniques, such as tracheostomy and continuous positive airway pressure, have been used to treat Obstructive Sleep Apnea (OSA) since the 1960s. Following it was understood that both maxilla and mandibula have significant effect on upper airway dimensions, maxillomandibular advancement (MMA) appeared to be an efficient treatment option for OSA. Although MMA is generally chosen as the second phase treatment following phase-one treatments like nasal plasty, tonsillectomy, uvulopalatoplasty (UPP), uvulopharyngopalatoplasty (UPPP), and genial advancement surgeries, several studies reveal that “MMA only” approach can be chosen because of its high success rate in long term. MMA can be well tolerated in aging patients because of the augmenting effect of the procedure on the facial soft tissues. 3 dimensional virtual planning of MMA may be more convenient for predicting the effect of the advancement amount on upper airway enlargement. MMA with counterclockwise rotation and advancement genioplasty (in appropriate cases) seems to be the most effective movement for maximum upper airway volume gain. MMA surgery is generally performed using the conventional LeFort 1 osteotomy and bilateral sagittal split ramus osteotomy. If advancement genioplasty is planned, then the chin segment should include the genial tubercles. Bradycardia or asystole risk should be closely monitored during immobilization of the maxilla because of the risk of trigeminal-cardiac reflex development following extensive maxillary advancement. Undesired occlusal alignment or fixation problems are the most common reasons for revision surgery in the early postoperative phase. An average 80.1% reduction in the apneahypopnea index was observed following the MMA procedure. MMA is an effective surgical method for the treatment of OSA, achieving a high success rate with stable long-term improvement in OSA indicators.