Maxillomandibular advancement surgery (MMA) is an effective treatment for obstructive sleep apnea (OSA). In MMA, the maxilla and mandible are repositioned to relieve airway obstruction. This procedure also suspends the attached pharyngeal airway muscles in an anterior position while increasing the tension on the pharyngeal soft tissues.
In contrast to all other surgical procedures for OSA, all airway levels from the nasal cavity to the hypopharynx are affected. At the Mayo Clinic, the vast majority of patients, even those with severe OSA, have successful outcomes. In fact, more than half of patients achieve elimination of obstructive sleep apnea (apnea-hypopnea index less than 5).
The common belief is that MMA is only used in patients with craniofacial deformity (mandibular retrognathism). However, in fact, patients with normal bone structure (ie, OSA with excess soft tissue, including obesity) are often candidates for surgery and have similarly good outcomes.
Another view is that MMA is a “salvage” surgical option after other soft tissue surgeries, such as uvulopalatopharyngoplasty (UPPP), have been tried and failed. If surgical treatment is required, MMA should be considered in any patient with moderate to severe OSA.
In this craniofacial surgery, 3-D imaging is utilized for preoperative virtual scanning to maximize accuracy and efficiency in the operating room. After surgery, patients are typically monitored overnight in an ICU setting, and the length of stay is usually two to three nights.
Pain is generally less than that experienced with soft palate surgery (such as UPPP), and at discharge, most patients' pain can be controlled with non-opioid analgesics. Manipulation of facial sensory nerves during surgery can cause paresthesia, which actually blunts the pain response in the short term. Importantly, because current internal bone fixation devices for MMA do not require mandibular wiring, patients can begin a soft mechanical diet immediately.
Changes in facial appearance depend primarily on preoperative anatomy (dysmorphic vs. non-dysmorphic) and degree of obesity. Studies show that 70% of patients feel their facial appearance improves after MMA; 20% to 25% report little change in appearance. Long-term negative sequelae are rare, but this surgery must be viewed like any other orthopedic surgery - final results and conditions will occur within 9 to 12 months.
Recovery takes about six weeks, and most patients begin to gradually return to normal work or school activities after three weeks. Postoperative polysomnography is usually performed three months later after soft tissue edema has subsided.
