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Maxillomandibular Advancement for Sleep Apnea

Skeletal expansion of the upper airway for severe obstructive sleep apnea

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Ağız ve Diş Sağlığı department. Book Appointment →

What is Maxillomandibular Advancement for Sleep Apnea?

Maxillomandibular advancement (MMA) treats obstructive sleep apnea by skeletally enlarging the upper airway. By advancing both the maxilla and mandible 8-12 mm, the procedure increases pharyngeal cross-sectional area at all levels (retropalatal, retroglossal, hypopharyngeal), reduces airway collapsibility, and tensions the suprahyoid muscles to maintain patency during sleep.

MMA is indicated for adults with moderate-to-severe OSA (apnea-hypopnea index AHI ≥ 15) who fail or cannot tolerate continuous positive airway pressure (CPAP), demonstrate skeletal contributors (mandibular hypoplasia, retrognathia, narrow maxilla), and remain symptomatic. Contraindications include morbid obesity (BMI > 40), severe medical comorbidity, and active substance abuse.

Multidisciplinary evaluation includes sleep medicine, otolaryngology, dental, and oral and maxillofacial surgery. Workup includes polysomnography, drug-induced sleep endoscopy (DISE), CBCT with airway analysis, lateral cephalometry, and dental impressions. Virtual surgical planning, custom titanium plates, and CAD/CAM splints optimize outcomes. Success rates of 85-95% (≥ 50% AHI reduction) are reported, with cure rates (AHI < 5) of 40-60%.

Symptoms

Loud habitual snoring
Witnessed apneas during sleep
Excessive daytime sleepiness (Epworth Sleepiness Scale ≥ 10)
Morning headaches
Nocturia
Choking or gasping awakenings
Cognitive impairment, memory difficulty
Mood disturbance, irritability
Hypertension, atrial fibrillation, stroke risk
Type 2 diabetes mellitus association
Erectile dysfunction
Treatment-resistant hypertension
CPAP intolerance or failure
Mandibular advancement device (MAD) failure
Skeletal disproportion (mandibular retrognathia, narrow maxilla)

Risk Factors

Mandibular retrognathia or hypoplasia
Narrow or high-arched maxilla
Class II skeletal pattern
Long face syndrome (vertical maxillary excess)
Obesity (relative consideration)
Male sex
Age 30-65 years
Family history of OSA
Postmenopausal status (women)
Tonsillar hypertrophy (relative)
Macroglossia
Allergic rhinitis or chronic sinusitis
Hypothyroidism
Acromegaly
Down syndrome and other craniofacial syndromes
Smoking
Alcohol use

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Loud snoring with witnessed apneas
  • Excessive daytime sleepiness despite adequate sleep
  • Diagnosed moderate-to-severe OSA (AHI ≥ 15)
  • Failed or intolerant of CPAP
  • Failed mandibular advancement device
  • Hypertension difficult to control
  • Atrial fibrillation
  • Stroke or transient ischemic attack history
  • Skeletal disproportion (mandibular retrognathia)
  • Quality-of-life impairment from OSA symptoms
  • Considering surgical alternatives to CPAP
  • Drug-induced sleep endoscopy showing multilevel obstruction

Treatment Methods

01
Multidisciplinary evaluation by sleep medicine, oral and maxillofacial surgery, otolaryngology, and dental specialists
02
Polysomnography (PSG) for AHI confirmation and severity
03
Drug-induced sleep endoscopy (DISE) to identify obstruction levels
04
CBCT with airway analysis (cross-sectional area, volume)
05
Lateral cephalometry and 3D facial analysis
06
Dental impressions and occlusion analysis
07
Failed CPAP and mandibular advancement device documentation
08
Medical optimization (weight loss, blood pressure control, smoking cessation)
09
Virtual surgical planning with airway simulation
10
Patient-specific or stock titanium plate fixation design
11
CAD/CAM intermediate and final occlusal splints
12
General anesthesia with nasoendotracheal intubation
13
Le Fort I osteotomy with maxillary advancement (8-12 mm)
14
Bilateral sagittal split osteotomy with mandibular advancement (8-12 mm)
15
Genioplasty for chin advancement (often combined)
16
Rigid fixation with titanium plates and screws
17
Hypotensive anesthesia and tranexamic acid
18
Postoperative ice and head elevation
19
Multimodal analgesia
20
Antibiotic prophylaxis
21
Liquid to soft diet for 6 weeks
22
Light orthodontic elastics for occlusion guidance
23
Postsurgical orthodontic finishing for 6-12 months
24
Postoperative polysomnography at 3-6 months
25
Long-term follow-up for skeletal stability and OSA recurrence
26
Concurrent or staged uvulopalatopharyngoplasty if multilevel obstruction
27
Lifestyle modifications (weight management, alcohol avoidance, sleep position)

Which Department to Visit?

You can visit our Ağız ve Diş Sağlığı department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.