Maxillomandibular Advancement for Obstructive Sleep Apnea: Is It Right For You?

November 11, 2009

With all the surgical options for obstructive sleep apnea, maxillomandibular advancement (or the MMA) is not mentioned too often as a first line treatment option. Historically, it’s thought to be a big procedure with lots of potential complications, and a long recovery.

The MMA involves cutting the upper and lower jaws and pushing it forward 1 cm or more and fixing it in place using plates and screws. It’s typically reserved for patients that can’t tolerate CPAP, or who’ve failed other soft tissue procedures.

A recent paper published in Otolaryngology – Head & Neck Surgery reported on the complications of 59 patients that underwent this procedure. They reported an 80% success rate with no serious complications. Minor complications included 6 cases of fixation plate infection requiring removal, 2 cases of minor bleeding and one case of vein inflammation. Ninety-four percent reported numbness of the lip area immediately after the procedure, and after 18 months, 52% still complained of numbness.

Despite these complications, the vast majority (94%) were happy with the overall results and would recommend the procedure to family and friends. Many patients were also happy that although their facial appearance changed (usually for the better), they also looked younger, which is due to the facial stretching effect of the procedure.

Overall, success rates for the MMA are reported to be from 80% up to 97%. This is much better than multi-level soft tissue surgeries which are no better than 80%. In this particular study, the average distance the jaws were moved was .7 cm, which is much less than what’s typically achieved (over 1 cm). Also, many of the patients that "failed" had large tonsils and bulky soft palate tissues, in addition to being more overweight.

Perhaps one way of increasing the overall chances of success if to address any soft tissue areas of obstruction first, and of the 20 or so percent that don’t respond, offer them the MMA procedure. It’s also important to move the jaws the maximum distance possible, but that’s not as easy as it sounds.

Granted this procedure is not for everyone, but once you begin to look at surgical options, you should at least know about what’s involved the the MMA.

Written by Steven Park · Filed Under Blog
Tagged: ,maxillomandibular advancement, MMA, obstructive sleep apnea, UPPP

6 Responses to “Maxillomandibular Advancement for Obstructive Sleep Apnea: Is It Right For You?”

David Stillwagon on November 11th, 2009 9:42 am

Dr. Park,
How long does the surgery take and how long is the recovery period?
thanks
David
Dr. Steven Y. Park on November 11th, 2009 10:03 am

Anywhere from 3-6 hours, and full recovery can take 4-6 weeks. You may also need further orthodontic work afterwards to better align your teeth. Different surgeons have widely different approaches and outcomes.
James Ralston on November 21st, 2009 3:54 pm

I recently had MMA surgery. The surgeons advanced the upper and lower jaw 7.5 mm. He said he initially tried 10 mm but this stretched the soft tissues too much. He also cut through two nerves. I was hoping for more. What really is getting me down is that my lower lip and chin, and part of the left side of my face is numb. From reading postings on this subject, it seems that the majority of patients that have gone through this procedure have permanent numbness. I did not know this bad side effect was so common. I am hoping that it is not permanent, and it is causing me to be depressed. In addition, I may have put myself through this ordeal and still not have my sleep apnea cured. Any comments?
Steven Park on November 22nd, 2009 4:51 am

Mr. Ralston,

Your disappointment is understandable after the results that you’ve just experienced. The MMA is not a completely benign procedure. Numbness is a common complication. Sometimes, the bigger the potential for success, the higher the risk.

In some cases it can take 6-12 months for the numbness to improve, so give it more time. See what the sleep study shows 6-12 months after the procedure, and have a discussion with your surgeon about the results, as well as other options.
James Ralston on December 5th, 2009 10:10 pm

I recently had MMA surgery. The surgeon had to approximate two nerves. It has been two and a half weeks and I am experience tingling, pulsing in the areas that are numb, which is the lower lip and chin. Does this mean the nerve is regenerating. It is hard to sleep since this never seems to stop.
Marie on December 9th, 2009 8:55 pm

Check out this website http://www.sleepnet.com under the non-cpap options message board. many people who have had the mma surgery post on these message boards including an mma surgeon named Dr. Kasey Li whom Dr. Park has interviewed in the past. The people on the board are very nice and helpful. They even have an annual mma surgery meetup in Northern California.