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.
To listen to an interview with Stanford University surgeon Dr. Kasey Li, click here.