Understanding Maxillomandibular Advancement for Treating Obstructive Sleep Apnea

Introduction and Terminology

Obstructive sleep apnea (OSA) is a common yet concerning sleep disorder, affecting nearly 3% to 7% of the male population and 2% to 5% of the female population in the United States. It can lead to multiple health issues if left untreated. When conservative treatments, such as Continuous Positive Airway Pressure (CPAP) therapy or lifestyle modifications, fail to produce results, surgical intervention might be the next step.

One surgical option is Maxillomandibular Advancement (MMA), a procedure that involves moving the upper (maxilla) and lower (mandible) jaws forward to enlarge the airway. This technique has been used effectively in treating OSA, reducing sleep apnea episodes in approximately 86% of patients.

Indications for Maxillomandibular Advancement

Maxillomandibular Advancement surgery is generally indicated for patients with moderate to severe Obstructive Sleep Apnea who have not responded adequately to non-surgical treatments. Specific indications include:

• Failure or intolerance of CPAP therapy, or unwillingness to use it.
• Presence of anatomical abnormalities that contribute to airway obstruction, including small jaw or large tongue.
• OSA severity causing serious health issues such as heart problems or high blood pressure.
• Weight is stable and within the recommended range, reducing the risks of surgery.

Each case is unique, and it’s essential for patients to have a thorough consultation with their healthcare provider to determine the best treatment option. While the surgery has proven beneficial in many cases, it’s not suitable for everyone. Potential risks and benefits should be carefully weighed before making a decision.

Pre-Op Preparation

Once Maxillomandibular Advancement surgery has been determined as the right course of action, there are several steps to prepare for the procedure.

• Fasting: Patients will likely need to fast for at least 8 hours before surgery. This includes avoiding food, drink, and certain medications.
• Adjustments to medications: Some medicines may need to be stopped or adjusted before surgery. Your doctor will provide specific instructions.
• Pre-op labs and imaging: Certain diagnostic tests may be necessary to ensure you’re fit for the procedure.
• Transportation: Arrange for someone to drive you home after surgery, as you’ll be under the effects of anesthesia.
• Work or school notes: Be prepared to take some time off for recovery and have necessary documentation in place.

Please note that these are general guidelines. Your doctor will provide you with detailed instructions tailored to your specific condition and health status. Always follow your doctor’s advice regarding pre-operative preparation and post-operative care. Our primary care practice offers telemedicine services, including pre-operative clearances and ordering of pre-op labs and imaging, to assist you in your preparation for surgery.

Procedure Technique for Maxillomandibular Advancement

Maxillomandibular Advancement (MMA) is a surgical procedure that aims to increase the airway size by moving the upper and lower jaws forward. This section aims to demystify the process, breaking it down into understandable steps for you as the patient.

The surgery typically occurs under general anesthesia, which means you’ll be asleep and won’t feel any discomfort during the operation.

Step 1: Incisions and Exposure

The first step of the surgery involves the surgeon making incisions inside your mouth. This allows the surgeon to access the lower and upper jaw bones (the mandible and maxilla). This approach avoids visible scars on the face.

Step 2: Osteotomy

Once the surgeon has proper access, the next step is the osteotomy, or bone cutting. This involves creating precise cuts in the mandible and maxilla. Your surgeon uses specialized tools and their expert knowledge to do this carefully, preserving the surrounding structures and nerves.

Step 3: Bone Repositioning

After the osteotomy, the surgeon then moves both your upper and lower jaws forward. This process, called bone advancement, is aimed at increasing the size of your airway to improve your breathing during sleep.

Step 4: Fixation

Once the jaws are in their new position, the surgeon secures them with small plates and screws. This fixation process ensures that the bones stay in their new place while healing. These plates and screws are typically made of materials that are safe and well-tolerated by the body.

Step 5: Wound Closure

The final step in the procedure is closing the incisions. The surgeon will use sutures that are absorbed by the body over time, meaning they won’t need to be removed later.

While these steps may sound straightforward, remember that MMA is a complex procedure that requires a skilled surgeon with expertise in maxillofacial surgery. Despite its complexity, the operation has a high success rate in the hands of an experienced surgeon and can significantly improve the quality of life for patients with severe obstructive sleep apnea.

However, like all surgical procedures, MMA carries some risks, including infection, bleeding, and nerve damage. These are rare, and your surgeon will discuss these potential risks with you in detail before the procedure. It’s essential to weigh the potential benefits of symptom relief and improved sleep against these potential risks.

This explanation of the MMA procedure aims to provide you with a basic understanding of what to expect. Every patient, every jaw, and every case of sleep apnea is unique, which means your surgeon may adjust these steps to best meet your specific needs.

Remember to ask your doctor if you have any questions or concerns. Open communication with your healthcare provider is key to understanding the procedure and making the best decision for your health.

Duration of Maxillomandibular Advancement

The Maxillomandibular Advancement (MMA) procedure typically takes about 3 to 5 hours, although this may vary depending on the complexity of the individual case and the surgeon’s experience.

Post-Op Recovery from Maxillomandibular Advancement

Following the procedure, you’ll likely stay in the hospital for 1 to 2 days for monitoring. After discharge, you will have a follow-up schedule with your surgeon to monitor your healing and adjust any necessary treatments.

Some discomfort and facial swelling is normal and can be managed with prescribed medications. Your diet may be temporarily adjusted to soft foods as your jaws heal. A period of rest is essential, so expect to take about 2 to 4 weeks off work.

Rehabilitation such as physical therapy is typically not necessary after MMA. However, lifestyle changes like maintaining a healthy weight and avoiding smoking can help improve the procedure’s effectiveness and your overall health.

Complete recovery and seeing the full benefits of MMA can take a few months as your body adjusts to the changes. Our primary care practice is here to assist you throughout the recovery process, providing documentation for work or school as needed, and offering extended weekday and weekend hours for your convenience.

Effectiveness of Maxillomandibular Advancement

MMA has demonstrated significant effectiveness in treating Obstructive Sleep Apnea. Studies show that around 86% to 90% of patients experience substantial improvement in their sleep apnea symptoms post-procedure.

The effectiveness of MMA can be influenced by several factors. A healthier body weight can increase the procedure’s success, as obesity is a known risk factor for sleep apnea. Age may also play a role, with younger patients often seeing better results than older patients.

It’s important to remember that individual results can vary. MMA is a complex procedure that should be customized to each patient’s needs and conditions. Your surgeon will consider multiple factors when determining the expected outcomes, including your overall health, the severity of your sleep apnea, and your jaw anatomy.

While the surgery is effective, it’s just one part of a comprehensive treatment plan for Obstructive Sleep Apnea. Lifestyle modifications, like weight management, regular exercise, and quitting smoking, are essential components to improve your sleep and overall health.

With careful patient selection and an experienced surgeon, MMA can provide significant and lasting relief from sleep apnea symptoms, improving sleep quality, daytime alertness, and overall quality of life.

Adverse Events with Maxillomandibular Advancement

While Maxillomandibular Advancement (MMA) is generally considered a safe procedure, there can be certain risks and complications. Some of the common ones include:

• Bleeding (2-5%): As with any surgical procedure, there’s a risk of bleeding during or after surgery. It is usually well-controlled but can lead to complications if severe.
• Infection (1-3%): Post-surgical infections can occur at the surgical site but are relatively rare due to antibiotic prophylaxis and sterile surgical techniques.
• Nerve damage (5-7%): There’s a risk of temporary or permanent damage to nerves in the surgical area, leading to changes in sensation or movement.
• Relapse (10-15%): In some cases, the bones may shift back to their original positions, reducing the benefits of the procedure.
• Temporomandibular joint (TMJ) dysfunction (5%): MMA can sometimes lead to issues with the jaw joint, leading to pain, difficulty chewing, or a change in bite.

The mortality rate for MMA is exceedingly low, estimated at less than 0.1%.

Alternatives to Maxillomandibular Advancement

There are other options available for treating Obstructive Sleep Apnea if MMA is not suitable or preferred. These include:

• Continuous Positive Airway Pressure (CPAP): This is often the first line of treatment, involving a machine that delivers pressurized air to keep the airways open during sleep.
• Mandibular advancement devices: These are dental appliances that adjust the position of the lower jaw and tongue to improve airway patency.
• Other surgical options: Procedures like Uvulopalatopharyngoplasty (UPPP) or Genioglossus advancement may be considered, based on the patient’s anatomy and severity of apnea.
• Lifestyle changes: Weight loss, regular exercise, reducing alcohol intake, and quitting smoking can help manage sleep apnea symptoms.

Experimental or Emerging Technologies

New technologies and treatments are constantly being developed for Obstructive Sleep Apnea. One such promising development is the use of hypoglossal nerve stimulation. This therapy involves implanting a small device that sends mild stimulation to the hypoglossal nerve, which controls tongue movements, to keep the airway open during sleep.

Conclusion

Maxillomandibular Advancement is a highly effective surgical treatment for Obstructive Sleep Apnea, but it’s essential to consider all the benefits, risks, and alternatives before proceeding. New treatments are on the horizon, and a multidisciplinary approach, including lifestyle changes, can contribute to overall health improvement. Always discuss with your healthcare provider to choose the most appropriate treatment for your individual condition and lifestyle.

Brief Legal Disclaimer: This article is for informational purposes only and not intended as medical advice. Always consult a healthcare professional for diagnosis and treatment. Reliance on the information provided here is at your own risk.