Maxillomandibular Advancement or Jaw Surgery
Maxillomandibular advancement (MMA)—also referred to as bi-maxillary advancement (BI-MAX) or orthognathic surgery—is a type of surgical procedure used in patients with severe sleep apnea who have not responded well to treatment with CPAP machines. The procedure involves actually moving a patient’s jaws (upper and lower) forward to expand the area of the airway to the lungs. Usually this area is obstructed by a patient’s tongue and his or her soft and hard palates (which together make up the roof of the patient’s mouth).
There are several types of surgical procedures available for treatment of obstructive sleep apnea—including UPPP, genioglossus surgery, hyoid surgery and tongue reduction surgery—but maxillomandibular advancement has been in general one of the more successful surgeries. Although, unless a structural problem with the jaw has been diagnosed as the primary mode of obstruction, many patients will normally try out other types of surgeries before jaw surgery.
Maxillomandibular advancement is a very invasive procedure that generally requires a longer recovery time. There are also many possible complications, including severe bleeding, infection, difficulty swallowing (dysphagia) and a worsening of breathing problems. Moving the jaw forward may also cause pain or numbness in the teeth and face and might significantly alter a person’s facial appearance, which greatly reduces demand for the procedure. And as with many surgeries, additional procedures may need to be ordered after a patient undergoes maxillomandibular advancement, if the results are inadequate or if complications arise which need surgery to repair.
Multiple surgeons will attend to the patient in the operating room. Before the procedure begins, the patient will be put under general anesthesia. Large incisions will be made inside the mouth and small incisions will be made on the outer flesh of the cheeks. The patient’s jaw will then be dislocated using surgical saws, repositioned and held in its new, advanced position using metal braces called arch bars, which are temporary and will be removed in a month and a half or so.
For the duration of the healing process after maxillomandibular surgery has been performed, it’s important that the patient consumes only liquids and soft foods. Chewing will be very difficult, even though the doctor will usually put rubber bands in place to help the patient bite down. Antibiotics and other medications will also be necessary for some patients to control pain, swelling and infection. If you are going in for jaw surgery with maxillomandibular advancement, also speak with your doctor about lifestyle changes you’ll need to make while in recovery—as physical activity including body position during sleep will need to be adjusted.