Maxillomandibular advancement | Sleep Apnea Jaw Surgery

Before and After Maxillomandibular Advancement Surgery

The featured image is of a patient with obstructive sleep apnea and class 2 malocclusion. The patient presented for treatment of her snoring, sleep apnea, and excessive daytime sleepiness. She also presented for correction of her abnormal bite and crooked teeth. After 12 months of orthodontic management, the patient was prepared for jaw surgery. Dr. Jose Barrera, MD, San Antonio Facial Plastic Surgeon and Sleep Specialist elected to perform a “double jaw” surgery to correct the obstructive sleep apnea symptoms as well as the malocclusion. The patient underwent a maxillomandibular advancement (MMA) with San Antonio Facial Plastic Surgeon Dr. Jose Barrera, MD to successful treat her sleep apnea and correct her overjet and overbite deformity.
San Antonio Facial Plastic Surgeon Dr. Jose Barrera, MD performs maxillomandibular surgery in patients with obstructive sleep apnea and malocclusion. Patients undergo orthodontic evaluation, bite analysis, and facial analysis prior to consideration for maxillofacial surgery.
An better smile, aligned bite, and improvement in the cosmetic facial appearance are common goals of maxillomandibular advancement. In addition, correction and improvement in obstructive sleep apnea is achievable with MMA.

Before and after maxillomandibular advancement for OSA

Surgical options to correct Obstructive Sleep Apnea

There are many surgical options to correct obstructive sleep apnea. The severity of the polysomnogram or sleep study and the lowest oxyhemoglobin saturation (LSAT) must be balanced with the patient desires for corrective surgery, the ability to tolerate or adhere to CPAP, and the patient’s occlusion and soft tissue obstruction. Combining these factors along with the patient phenotype and drug induced sleep endoscopy (DISE) grade can help determine which operation is best suited for the patient. For patients with skeletal dental abnormality and malocclusion, it may be necessary to pursue jaw surgery. Jaw surgery can be done as part of a phased protocol or as the primary surgery. Maxillomandibular advancement has the highest success rates with success greater than 90% in achieving a drop in the apnea hypopnea index by half and below 20 events per hour as well as improving the nightime oxygenation levels in patients with obstructive sleep apnea.