Maxillomandibular (MMA) (Upper/ Lower jaw) Advancement
Maxillomandibular Advancement procedure simultaneously moves the upper (maxilla) and lower (mandible) jaws forward, which in turn, would open the upper airway space at the back of the throat. This movement would open the upper airway space in three dimensions and give significant reduction in obstruction. Of all the procedures for treatment of obstructive sleep apnea (OSA), the maxillomandibular advancement (MMA), is the most effective in relieving the sleep apnea. In major studies it has been shown that obstructive sleep apnea patients treated with maxillomandibular advancement (MMA) in which up to 90% were successfully treated. This surgical treatment is the most efficacious procedure for expanding the upper (pharyngeal) airway space and improving or eliminating obstructive sleep apnea. It remains the best current alternative to tracheostomy.
Candidates for this surgery are patients with moderate to severe obstructive sleep apnea, severe lower jaw (mandibular) deficiency, morbid obesity, patients on CPAP or patients whom other sleep apnea procedures have failed.
This operation is performed under general anesthesia in a hospital setting which on average is about three to four hours. Patients usually are hospitalized an average of two to three nights. Recovery is about two to four weeks at which time patients may return to work.
Adjunctive orthodontic therapy is usually indicated in patients selected for MMA. Presurgical orthodontics improves the postoperative occlusion (coming of teeth together) and eliminates preexisting dental problems that would otherwise limit the amount of advancement. The jaws are not wired shut. Braces or arch bars (similar to orthodontic braces) are applied to the teeth temporarly. Upper and lower jaw bones are stabilized with titanium plates and screws for greater stability bone graft is also used to fill in the gaps between bony movements. There is no change in the bite, speech or swallowing. There should be no chewing of solid food and patients would be on liquid to soft diet about four weeks after surgery.
In our practice we use a 3D Craniofacial Cone Beam CAT Scanner by Kodak 9500 which is a low dose radiation x-ray. A 3D photographic image of the patient with the 3dMD cameras are obtained and combined with the 3D CT image together. Next a 3D computer model of the skin, soft tissue and bone is obtained with the aid of the 3dMDvultus software, which virtual surgery is preformed. This technology will prepare and allow the surgeon to visualize and calculate the correct movements of the jaw precisely before the actual surgery.
Patients should expect some swelling, minor oozing and transient numbness of the lips and chin area. Since both upper and lower jaws are moved together, there would be some changes in facial appearance which is usually esthetically pleasing. The success rate of MMA appears to increase when adjunctive procedures such genioglossus advancement (forward moving of tongue muscle and chin bone), septoplasty (nasal surgery), or turbinectomies (nasal passage surgery) are included in the treatment plan. This lends support to the theory that most obstructive sleep apnea patients have multiple levels of obstruction.
Complications with this surgery although temporary are the same for most surgeries which includes; bleeding, non-union of the bone, infection, malocclusion (altered bite), transient or permanent sensory disturbances of the lip and facial nerves, swelling.
Dr. Broujerdi and his associates have been engaged in clinical research with patients undergoing maxillomandibular advancement. They have been looking at how the upper airway space changes shape and volumertically using the pre and post Cone Beam CAT Scan and the 3dMDvultus software application. They have noticed a shape change from a funnel to a cylinder and up to 3 to 4 fold increase in the total volume change. The research has been presented at local and national meetings and up for publication.
To view more details about the upper airway analysis click on this link.
pre surgery 3D upper airway analysis shows a narrow funnel shaped airway
post surgery 3D upper airway analysis shows a wide patten cylinder shaped airway