Obstructive Sleep Apnea

Jaw Surgery for Obstructive Sleep Apnea

See types of jaw surgery page for animated illustrations of how jaw surgery is performed at Mayo Clinic.

Jaw surgery is sometimes called orthognathic surgery, referring to proper alignment of the upper and lower jaws, and sometimes called maxillomandibular advancement (MMA), referring to the maxilla (upper jaw) and mandible (lower jaw) and their advancement (movement forward) with surgery.

This surgery may be an option for adults and older adolescents with moderate to severe obstructive sleep apnea whose jaw structure worsens blockage of the airway. The goal is to move facial bones forward so that airway tissues (the tongue base and soft palate) are held up and out of the way, preventing airway collapse and obstruction during sleep.

It's often used when other treatments (such as weight loss, positional changes during sleep, oral appliances or CPAP) have failed, but is also sometimes used as the initial treatment.

The surgery is a process, not a one-time event. It involves in-depth evaluation by an oral maxillofacial surgeon and sometimes an orthodontist, pre-surgical orthodontics for some patients, the surgery itself, recovery, and aftercare.

The actual surgery is performed in a hospital operating room. Length of hospital stay varies, but is usually 1 – 3 days.

The surgery takes three main forms:

• LeFort advancement osteotomy moves the upper jaw forward
• Sagittal split osteotomy moves the lower jaw forward
• Genioplasty (or genial advancement) moves the chin forward

The decision as to which bone(s) to advance depends on a patient's facial anatomy and preference. Some patients have one jaw advanced, some both upper and lower (called bimaxillary advancement), and some have all three procedures.

During surgery, the surgeon cuts the jaw (called osteotomy), moves it forward, and secures it into position with plates and screws. When the bone is moved, the muscles and soft tissues attached to it come forward as well. In the case of chin surgery, this also includes the hyoid bone (u-shaped bone at the base of the tongue).

When performing upper jaw surgery, the surgeon also straightens the septum (bony divider between the nostrils) if it's bent, and removes from the nasal cavity small bones that can obstruct breathing.

All incisions are made inside the mouth.

Most healing takes place the first 8 weeks after surgery and most patients stay home from work or school a minimum of 3 weeks.

The recovery period can be uncomfortable, involving swelling, congestion, pain, and minor difficulty talking. Rarely patients will need to have their jaw wired closed during part of their recovery and some patients require minor orthodontic adjustments after the surgery.

The surgery can change a patient's facial appearance, which may take time to adapt to. Most patients, however, are pleased with the final appearance and the surgery is highly successful in reducing sleep apnea.