54-year-old female with severe obstructive sleep apnea and class 2 malocclusion. She underwent UPPP and genioglossal advancement which improved her OSA to a mild grade except in supine sleep where she remained severe. Given her persistent malocclusion, she underwent maxillomandibular advancement (MMA) with Dr. Barrera. An 8 mm Lefort I advancement with 3 mm impaction followed by a 12 mm counterclockwise bilateral sagittal split osteotomy was performed. Postoperatively, her sleep apnea resolved and a class I occlusion was achieved alongside orthodontic management.