What is the role of maxillary-mandibular advancement in the treatment of obstructive sleep apnea (OSA)?

Updated: Feb 25, 2021
  • Author: Charles E Morgan, DMD, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Answer

Maxillary-mandibular advancement is performed in an attempt to widen the airway while maintaining the existing occlusion or, optimally, to obtain class I occlusion. Outer-table cranial bone is obtained initially through a coronal incision. Arch bars are placed, and maxillary osteotomies are performed. The maxilla is advanced 8-12 mm. Mandibular osteometries are also performed, and the mandible is advanced to obtain optimal occlusion. Bone grafts are used at the osteotomy sites as needed. Intermaxillary fixation is necessary postoperatively.

A wide variety of maxillomandibular advancement techniques have been described, all with the goal of advancing skeletal support for the tongue and pharynx.

The results of maxillary-mandibular advancement are seen in the image below.

Maxillary-mandibular advancement in obstructive sl Maxillary-mandibular advancement in obstructive sleep apnea. Final appearance of the advancement with rigid fixation. Reprinted with permission from Elsevier [Hester JE, Powell NB, Riley RW, and Li KK. Maxillary-mandibular advancement in obstructive sleep apnea. Operative Techniques in Otolaryngology-Head and Neck Surgery. 2002;13(2):135-7].

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