Maxillomandibular advancement (MMA) surgery

Maxillomandibular advancement (MMA) surgery is a treatment for obstructive sleep apnea. It works by moving the upper and lower jaws forward to widen the airway, allowing air to flow more easily from your nose and mouth to your lungs. MMA surgery helps you breathe better while you sleep.

Specialists at the Penn Sleep Apnea Program provide expert care, including MMA surgery, for people with sleep apnea. We use advanced tools and techniques that can prevent breathing interruptions while you sleep to decrease fatigue and improve overall health.

The use of a continuous positive airway pressure (CPAP) machine while sleeping is a common treatment for people with sleep apnea, but it doesn’t work for everyone. Adults with moderate to severe obstructive sleep apnea who have received little benefit from CPAP or other treatments may be considered for MMA surgery.

Candidacy for maxillomandibular advancement surgery is decided individually, based on factors like overall health, severity of symptoms, and past treatment efforts. The sleep specialists at Penn Medicine will review your history and perform a thorough medical evaluation, including a sleep study where you’ll be monitored while you sleep. They’ll discuss their findings and review treatment options with you.

In the days before your MMA procedure, your Penn Medicine surgeon will use a 3D modeling technology called virtual surgical planning (VSP) to determine the precise placement of the jaw bones. This helps your surgeon plan for and guide your surgery with precision. If a bite correction is part of the MMA procedure, you’ll also have a consultation with an orthodontist.

On the day of surgery, the anesthesia team will give you medications to make you comfortable and put you to sleep. A breathing tube will be passed from your mouth to under your chin through a small incision. This breathing tube placement, also known as submental intubation, positions nasal structures optimally for breathing during surgery and provides surgeons with better access to the site. Heavy-duty braces called arch bars will then be placed on the upper and lower teeth to stabilize the jaws. These will remain in place for five to six weeks after surgery.

Through an incision inside the upper lip, the upper jaw (maxilla) is exposed and moved forward according to the 3D models. It’s secured in place using titanium plates and screws. Next, the lower jaw (mandible) is exposed through an incision inside the lower lip and moved forward based on the 3D models and secured. Very small incisions on each cheek are made to allow for screw placement.

The incisions are closed with absorbable sutures, and the breathing tube is returned to the mouth, where it will remain until you are awake and breathing well on your own. Finally, dental elastics are placed on the arch bars to help maintain jaw alignment and limit excessive movement as you heal.

After the procedure is done, you’ll be transferred to the recovery room and monitored closely as you wake up from anesthesia. Next, you’ll be transferred to the inpatient unit for further observation and care. People typically remain in the hospital for two to three days after maxillomandibular advancement surgery.

For the first few days, some light bleeding or oozing may occur. Keeping your head elevated helps. Low energy, pain, and swelling may persist for two to three weeks. You’ll be given medications to manage discomfort. Ice packs and sleeping upright will help reduce swelling. You may experience some numbness in the lower face and lips that should subside over time. Snoring is common but is expected to go away as swelling subsides. Be sure to follow all your care team’s instructions and contact them if you have any concerns.

Your first post-operative appointment is usually scheduled 10 to 14 days after surgery. The doctor will assess your healing and, if all is well, your dental elastics will be taken off and you can move from a liquid diet to a pureed diet.

Five to six weeks after surgery, you’ll undergo a sedated endoscopy to evaluate your airway and tissue healing, and your arch bars will be removed. Most people are able to return to work and start eating a soft diet after this.

Around three months after surgery, you should be able to resume a normal diet. You’ll also start physical therapy to increase your ability to open your mouth. A sleep study is scheduled to evaluate the success of the surgery.

Full recovery from MMA surgery may take six to 12 months.

The Penn Sleep Apnea Program is part of the Penn Sleep Center, one of only three sleep centers in the U.S. designated by the National Institutes of Health as a specialized center for sleep research. We offer some of the most advanced sleep medicine and treatment techniques available. This includes a technical method, pioneered by a Penn Medicine doctor, for placement of a breathing tube during MMA surgery. This less invasive technique, known as submental intubation, keeps the breathing tube out of surgical working areas in the mouth while allowing the structures of the nose to be positioned most effectively for breathing during surgery.

Our extensive treatment plans are based on research and experience. With a team of pulmonologists, otorhinolaryngologists, oral and maxillofacial surgeons, and head and neck surgeons, we work together to create innovative and effective treatments for people with mild to severe sleep apnea.