Thoughts on Maxillomandibular advancement surgery (MMA)?

[Dan22]

Hi all,

I recently had a consultation with a surgeon regarding Maxillomandibular Advancement (MMA) surgery after being referred for evaluation. My dentist and orthodontist have recommended this surgery for several reasons, primarily because they believe it could cure my obstructive sleep apnea (OSA). On the other hand, two otolaryngologists (ENTs) have advised against it, noting that the success rates for curing OSA with MMA vary widely.

Given these conflicting opinions, I’m feeling somewhat uncertain. There’s no guarantee the surgery will fully resolve my OSA, and I worry about undergoing a significant procedure that might bring limited benefit, beyond improving my jaw position (which is a functional issue, not aesthetic) and potentially stopping my teeth grinding.

To give some context: I’m a 25-year-old male, 6’6” tall, weighing between 190 and 205 pounds (~198 cm, ~86-92 kg), which my primary care physician generally considers underweight. The surgeon is understandably optimistic about curing my OSA with MMA, but I’d prefer to avoid intermediate-risk surgeries unless absolutely necessary.

I’m sure some reading this might think I’ve already decided against it, but part of me likes the potential world where I never have to touch a CPAP again, so I haven't completely written it off yet. I’d really appreciate hearing any post-op success stories or general thoughts on MMA surgery from those who have personal experience/know people who have opted for MMA.

Thanks in advance!

Best,
Dan

[ozij]

Maybe this forum is not the best source for the information you want.
You would have to assume that people whose MMA surgery succeeded came back to report about it, at least in the same number as those whose surgery failed.

When the doctors say the results "vary widely" there must be some research about that.
Here's the abstract of one recent paper:
Retrospective Analysis of the Polysomnographic and Airway Changes in Obstructive Sleep Apnea (OSA) Subjects Who Underwent Maxillomandibular Advancement (MMA) Surgery

https://www.joms.org/article/S0278-2391 ... 8/abstract

I linked to this one because of it mentions a before and after PSG comparison.
Whatever info you get, make sure you find out the final AHI. While AHI is not everything, a mere "redcution in AHi" or "relative reduction in AHI" isn't enough. Some studies define "success" as an AHI of 15 none of us who have stuck with CPAP would find that even remotely acceptable.

Teeth grinding is sometimes a result of OSA - which is not to say that yours comes from that source.

At 25 - how about giving yourself a year to try CPAP before you make the final decision? If you can get used to it, and if CPAP therapy helps you sleep well - maybe MMA is not necessarily the preferred solution for treating your OSA is

You may have other reasons to go through MMA surgery. It may even make CPAP therapy easier - but that's another story.

[Sleepzilla]

More medical papers for reference. The takeaway from the first link appears to be that resulting efficacy of the procedure depends greatly on accuracy of the surgical procedure, which of course implies the surgeon's training, skill, and experience etc.

Assessment of Surgical Accuracy in Maxillomandibular Advancement Surgery for Obstructive Sleep Apnea: A Preliminary Analysis

Maxillomandibular Advancement and Upper Airway Stimulation for Treatment of Obstructive Sleep Apnea: A Systematic Review