Upper/Lower Jaw (Maxillomandibular) Advancement
FOR A SLEEP SPECIALIST CALL (800) 547-5189:
Candidates for this surgery are patients with moderate to severe obstructive sleep apnea, severe lower jaw deficiency, morbid obesity, patients on CPAP or patients whom other sleep apnea procedures have failed.
This procedure simultaneously moves the upper jaw (maxilla) and lower jaw (mandible) forward, which in turn, would open the airway at the back of the throat.
This movement would open the upper airway in three dimensions and give significant reduction in obstruction. Of all the procedures for treatment of obstructive sleep apnea (OSA), the maxillomandibular advancement, 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 in which 98% were successfully treated. This surgical treatment is the most efficacious procedure for expanding the upper airway and improving or eliminating obstructive sleep apnea. It remains the best current alternative to tracheostomy.
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 jaw advancement. 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 except in some specific cases. Braces or arch bars (similar to orthodontic braces) are applied to the teeth temporarily. Upper and lower jaw bones are stabilized with titanium plates and screws for greater stability. There is no change in the bite, speech or swallowing. There should be no chewing and patients would be on liquid to soft diet about four weeks after 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 minimal changes in facial appearance which is usually esthetically pleasing. The success rate of the upper and lower jaw advancement appears to increase when adjunctive procedures such as palate surgery, partial glossectomy (reduction in tongue size), genioglossus advancement (forward moving of tongue muscle), 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, infection, malocclusion (altered bite), transient or permanent sensory disturbances of the lip and facial nerves, swelling.
For more information on Sleep Disorders and Upper and Lower Jaw (Maxillomandibular) Advancement call Olympia Medical Center and ask for a sleep specialist (800) 547-5189.