Maxillomandibular Advancement (MMA) Surgery

Who Is a Candidate for MMA?

Maxillomandibular advancement surgery may be a treatment option for adult patients with obstructive sleep apnea who cannot tolerate continuous positive airway pressure (CPAP) therapy. Additional criteria may include:

• Structural jawbone abnormalities
• An excess of soft tissue in the mouth
• Previous soft tissue surgical procedures were unsuccessful in managing the patient’s sleep apnea

Preparing for MMA Surgery

Before scheduling this craniofacial procedure, your surgeon will take an extensive medical history and perform a physical exam. A CT scan of your face and jaw will be used to create a 3D model of your teeth to maximize accuracy in the operating room.

Your surgeon will advise any medications that should be stopped prior to surgery. As with all major surgeries, you should fast for at least 12 hours before your procedure. For your safety, all of your doctor’s pre-surgery instructions must be followed exactly.

How the Procedure Is Performed

MMA is a major surgery that is done in the hospital under general anesthesia. The operation will typically require one to two days of recovery in the hospital.

Using the CT images of your face and jaw and the 3D model of your teeth as guides, the surgeon will move the bones of the upper and lower jaw forward through tiny incisions inside the lips. The bones are secured in the new position with titanium screws and plates. Repositioning the jaw bones enlarges and opens the airway at multiple points. Over time, the soft tissues nearby will also shift and adjust, providing further expansion.

Once the incisions have been closed with absorbable sutures, the patient is moved to the post-anesthesia recovery unit (PACU) for close observation. Once the patient is stable, they will be transferred to an inpatient or care unit for monitoring.

What to Expect after Discharge

Patients will return home with their upper and lower jaw held together by rubber bands. Follow-up visits with the surgeon are typically scheduled weekly for four to five weeks after surgery. The rubber bands will be progressively removed at these visits.

For two weeks after surgery, patients are restricted to a full liquid diet. As follow up visits occur and the rubber bands are removed, patients may transition to foods that are pureed to the consistency of mashed potatoes and then to a soft foods diet before returning to normal diet.

Additional milestone steps in recovery are listed below. This is a general timeline only and will vary based on each person’s individual progress.

Weeks Three & Four

A gradual return to normal work or school activities may be approved if a patient is recovering as expected with no complications.

Week Six

Once initial jaw healing has occurred, braces will be fitted to finish aligning the teeth. The orthodontic phase of treatment can last several years.

Three Months

When soft tissue swelling has resolved, a follow up sleep study will be conducted to evaluate the success of the procedure.

Nine to Twelve Months

Healing is complete and the final functional and cosmetic results of the procedure can be evaluated.

Common Side Effects of MMA Surgery

Due to the liquid-only diet and discomfort often experienced with eating, many patient will lose 15 pounds or more in the weeks following surgery. This can be a positive outcome for some patients, because sleep apnea is often associated with excess weight. Patients will be encouraged to maintain a healthy weight with improved eating habits and exercise.

In addition to some degree of post-operative pain that can usually be managed with non-opioid medications, other side effects may include:

• Swelling of the soft tissues in and around the mouth
• Numbness of the lips, mouth, cheeks and/or chin (usually temporary)
• Bite changes
• Nasal congestion due to blood clots associated with surgery