Maxillomandibular advancement: a primary solution for sleep apnea?

If you suffer from obstructive sleep apnea (OSA) and CPAP doesn't work for you, your doctor will start outlining various surgical approaches to treating the disease. But will he or she recommend a procedure that appears to be more successful than any other?

The answer may be no. The most commonly performed treatment for OSA remains uvulopalatopharyngoplasty (UPPP, sometimes UP3). This is a relatively inexpensive outpatient treatment involving surgical removal of the uvula and adjacent throat tissue. The goal is to make more space for air to travel through your airways.

Although not a complex procedure, UPPP recovery can be extremely painful. Long-term results are not all that impressive. A review of 337 patients from 37 reports showed only 41% showed significantly improved scores on standard apnea indices.

In marked contrast, another procedure, known as maxillomandibular advancement (MMA) has been shown to have a 95% or better success rate. MMA is more complex than UPPP. It involves cutting through the maxillary and mandibular bones of the upper and lower jaw, then "advancing" them (outward from the face). The surgeon pulls forward tissues connecting these bones to the upper airway, thereby enlarging the space inside the airway.

MMA is an inpatient procedure. The patient's jaw will be wired shut for some weeks (rubber bands may be used) and it may take months before the teeth have settled enough to allow a normal diet. But, interestingly, few patients report the extreme levels of pain that UPPP patients do. (For first hand accounts of MMA and UPPP experiences, see SleepNet's Non-CPAP Forums in the Sleep Apnea section).

Because MMA requires more expertise -- typically involving cooperation between the patient's dentist and ENT specialist -- and costs more, your doctor may see MMA as a last resort. But, increasingly, MMA is being advocated as a primary operation that may be safer, less invasive and more effective than pharyngeal surgery (which often has to be performed in stages). This position was explored in a cover article in the November 2002 issue of the Journal of the American Dental Association.

MMA is not for everyone, of course, but if you are headed toward a surgical remedy for OSA, make sure your doctor considers the MMA option. Many insurance companies will cover the costs, although it may not be easy to find an in-network physician to perform the procedure.

Incidentally, although you wouldn't consider MMA for simple snoring, the principle of jaw advancement certainly applies to many snorers. Many of us have found we can prevent our snoring by wearning inexpensive dental devices that act to hold the jaw forward at night, keeping the airways open.

* For more on MMA: read this Lexington Clinic article

Is this information useful to you? Send us questions or feedback.  And remember, information provided by PutanEndtoSnoring does not substitute for the advice of your physician. 

  Feature article:  ADHD, or simply sleep-deprived?

Some children diagnosed with attention deficit hyperactivity disorder may simply be tired because their snoring is disturbing their sleep, researchers say.

A new study published in this month's Pediatrics found that 26% of 5-7 year olds who showed signs of mild ADHD also snored and had symptoms of obstructive sleep apnea.  Those with severe ADHD didn't snore any more than a "normal" control group of children. 

A tentative conclusion: before you drug your child to control his or her ADHD,  check to see whether he or she snores.  If so, consult your doctor to see whether you need to address a potential sleep disorder.  Snoring and sleep apnea in young children can often be addressed by tonsillectomy.  You may find your child can focus a lot better when he or she is not sleepy!

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This section features a current posting to our forum.   For some months we have been watching a thread called How to deal with waking your lover.... Here's a post which again points out how disruptive snoring can be to marital relationships.

My husband "or" I have been sleeping in separate rooms for 2 years now. I have decided it is either be woken up in his anger at my snoring or start out in a different room all together. If I sleep in a different room to begin with, there is less chance that I will be awakened by him and get a few more hours sleep. We can't live like this forever as my neck hurts daily and my head is really beginning to ache more frequently as well as staying exhausted all day every day. I do work and have to be alert as I report directly to the drs at the medical practice where I work. HELP!!!!! My husband tries to be supportive but volunteered to take a night job in order to get away from my snoring. My daughter can hear me upstairs nightly. I can no longer live like this. Snoring is wrecking my life!!!! PH

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