Because adenotonsillectomy does not always achieve complete resolution of airway obstruction, many children continue to suffer from sleep apnea. Moreover, as children develop into adolescents, the problem worsens due to enlargement of the airway muscles, especially the tongue: the airway is, in essence, confined by the upper and lower jaws. By moving the upper jaw (maxilla) and lower jaw (mandible) forward, the entire airway can be enlarged. This procedure serves as the most effective surgical treatment for obstructive sleep apnea. Since the majority of patients have either small upper and/or lower jaws, dental crowding is often present, and many adolescents can benefit from orthodontic treatment. Therefore, most of the adolescents or other young patients who undergo MMA seek orthodontic treatment at the same time to improve the occlusion.
This procedure is performed in a hospital surgery center under general anesthesia.
Maxillomandibular advancement surgery is four to five hours in duration. Hospitalization is usually two to three days and in general the patient can return to work in four weeks.
In general, the jaws do not need to be wired after surgery because they are stabilized. The integrity of the bite is preserved through the use of small titanium plates and screws, as well as braces (or arch bars) and rubber bands. Chewing is avoided for four weeks. Speech and swallowing are not affected but this procedure is associated with pain, swelling and temporary numbness of the lower lip and chin. Some changes in facial appearance will occur but is usually quite acceptable. This procedure is occasionally performed with genioglossus advancement or nasal surgery.
Li KK, Meara JG, Alexander A. Location of the Descending Palatine Artery in Relation to the Le Fort I Osteotomy. Journal of Oral and Maxillofacial Surgery; 54(7):822-825, 1996.
Li KK. Experimental Study of the Safety of Simultaneous Nasal and Le Fort I Osteotomies. Journal of Oral and Maxillofacial Surgery; 55(4):371-374, 1997.
Riley RW, Powell NB, Guilleminault C, Pelayo R, Troell RJ, Li KK. Obstructive Sleep Apnea Surgery: Risk Management and Complications. Otolaryngology - Head and Neck Surgery; 117(12):648-652, 1997.
Li KK, Riley RW, Powell NB, Troell RJ, Guilleminault C. Overview of Phase II Surgery for Obstructive Sleep Apnea Syndrome. Ear Nose and Throat Journal; 78(11):851-857, 1999.
Li KK, Powell NB, Riley RW, Zonato A, Troell R, Guilleminault C. Post-operative Airway Findings after Maxillomandibular Advancement for Obstructive Sleep Apnea Syndrome. Laryngoscope; 110:325-7, 2000.
Li KK, Powell NB, Riley RW, Zonato A, Gervacio L, Guilleminault C. Morbidly Obese Patients with Severe Obstructive Sleep Apnea Syndrome: Is Airway Reconstructive Surgery a Viable Option? Laryngoscope; 110;982-7, 2000.
Guilleminault C, Kim Y, Palombini L, Li K, Powell N. Upper Airway Resistance Syndrome and its Treatment. Sleep; 23:S197-S200, 2000.
Li KK, Powell NB, Riley RW, Guilleminault C. Maxillomandibular Advancement for Persistent OSA after Phase I Surgery in Patients Without Maxillomandibular Deficiency. Laryngoscope; 110:1684-1688, 2000.
Li KK, Riley RW, Powell NB, Gervacio L, Troell RJ, Guilleminault C. Obstructive Sleep Apnea Surgery: Patients’ Perspective and Polysomnographic Results. Otolaryngology - Head and Neck Surgery; 123:572-575, 2000.
Li KK, Riley RW, Powell NB, Zonato A. Fiberoptic Nasopharyngoscopy for Airway Monitoring Following Obstructive Sleep Apnea Surgery. Journal of Oral and Maxillofacial Surgery; 58:1342-1345, 2000.
Li KK, Riley RW, Powell NB, Guilleminault C. Patient’s Perception of the Facial Appearance After Maxillomandibular Advancement for Obstructive Sleep Apnea Syndrome. Journal of Oral and Maxillofacial Surgery; 59:377-380, 2001.
Li KK, Powell NB, Riley RW, Troell RJ, Guilleminault C. Long-term Results of Maxillomandibular Advancement Surgery. Sleep and Breathing; 4:137-139, 2000.
Li KK, Troell RJ, Powell NB, Riley RW, Guilleminault C. Uvulopalatopharyngoplasty, Maxillomandibular Advancement and the Velopharynx. Laryngoscope; 111:1075-1078, 2001.
Li KK, Powell NB, Riley RW, Guilleminault C. Distraction Osteogenesis in Adult Obstructive Sleep Apnea Surgery: A Preliminary Report. Journal of Oral and Maxillofacial Surgery; 60:6-10, 2002.
Li KK, Guilleminault C, Riley RW, Powell NB. Obstructive Sleep Apnea, Maxillomandibular Advancement and the Airway: A Radiographic and Dynamic Fiberoptic Examination. Journal of Oral and Maxillofacial Surgery; 60:526-530, 2002.
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Li KK, Powell N, Riley R. Postoperative Management of the Obstructive Sleep Apnea Patients. Oral and Maxillofacial Surgery Clinics of North America; 14:401-404, 2002.
Li KK. The Use of Distraction Osteogenesis in Sleep Apnea Surgery. Operative Technique of Otolaryngology-Head and Neck Surgery.
Li KK, Powell N. Lower Pharyngeal Airway Surgery: Maxillomandibular Advancement. In: Fairbanks, DNF, Mickelson SA and Woodson BT, editors. Snoring and Obstructive Sleep Apnea, 3rd edition. Philadelphia, PA, Lippincott, Williams & Wilkins, 2003.
Li KK, Riley R, Powell N. Complications of Obstructive Sleep Apnea Surgery. Oral and Maxillofacial Surgery Clinics of North America;15:297-304, 2003.
Li KK. Surgical Management of Obstructive Sleep Apnea. Clinics in Chest Medicine; 24:365-370, 2003.
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Li KK. Surgery of the Tongue and Hypopharynx - Skeletal Technique (Maxilla and Mandible). In: Terris DJ, Goode RL, editors. Surgical Management of Sleep Apnea and Snoring. New York, New York, Marcel Dekker, Inc. 2005.
Li KK. Surgical Therapy for Obstructive Sleep Apnea Syndrome. Seminars in Respiratory and Critical Care Medicine; 26:80-88, 2005.
Li KK. Surgical Therapy for Adult Obstructive Sleep Apnea. Sleep Med Rev; 9(3): 201-209, 2005.