Jaw advancement surgery and related procedures that enlarge the airway for adults with obstructive sleep apnea, coordinated with your sleep physician.
Obstructive sleep apnea (OSA) happens when the airway at the back of the throat repeatedly narrows or closes during sleep. Breathing pauses, oxygen levels dip and sleep is broken, often many times an hour, without you realizing it. The results can include loud snoring, daytime sleepiness, morning headaches and poor concentration, and over time OSA is associated with high blood pressure, heart disease and other health problems.
Where surgery fits
The first-line treatment for most adults is positive airway pressure (CPAP), and many people do well with it. Others sleep better with an oral appliance made by a dentist that holds the lower jaw forward. Surgery is generally considered for adults with moderate to severe OSA who can't tolerate CPAP or haven't benefited from it, or whose jaw structure is a clear cause of the narrow airway. A diagnosis from a sleep study, and the involvement of your sleep physician, are part of every evaluation.
Maxillomandibular advancement
The most effective jaw-based surgery for OSA is maxillomandibular advancement (MMA). Your surgeon moves the upper and lower jaws forward, usually by around 10 millimeters. Because the tongue and soft palate are attached to the jaws, they move forward too, opening the airway behind them. Published studies report large reductions in breathing events for most patients after MMA, and many no longer need CPAP, though results vary and a follow-up sleep study confirms the outcome.
MMA is often combined with genioglossus advancement, which moves forward the part of the chin where the main tongue muscle attaches. Some patients have this, or a genioplasty, alone.
Planning, surgery and recovery
Your evaluation includes a review of your sleep study, an airway and facial exam, and a 3D cone-beam CT (CBCT) scan that shows the airway and jaws. The movements are planned with virtual surgical planning, and your surgeon shows you what the change will look like. Moving the jaws forward also changes your profile, typically by making the lower face look fuller; for many patients that is a welcome change, and it is discussed openly.
MMA is performed in a hospital under general anesthesia, through incisions inside the mouth, with the bones held by titanium plates. Most patients stay one or two nights. Expect significant swelling for two to three weeks, a liquid then soft diet for about six weeks, and two to four weeks off work. Numbness of the lips and chin is common at first and usually improves over months. Some patients need orthodontic treatment to fine-tune the bite.
Sleep apnea surgery is billed to medical insurance. We prepare the pre-authorization with you and your sleep physician and estimate your share in writing.
