Large maxillomandibular advancements for obstructive sleep apnea: An operative technique evolved over 30 years

• Published in: Journal of cranio-maxillo-facial surgery Vol. 43; no. 7; pp. 1113 - 1118
• Main Authors: Camacho, Macario, Liu, Stanley Yung, Certal, Victor, Capasso, Robson, Powell, Nelson B, Riley, Robert W
• Format: Journal Article
• Language: English
• Published: Scotland Elsevier Ltd 01.09.2015
• Subjects: Dentistry; Female; Genioglossus advancement; Humans; Male; Mandible - surgery; Mandibular Advancement - methods; Maxilla - surgery; Maxillomandibular advancement; Obstructive sleep apnea; Operative Technique; Sleep Apnea, Obstructive - surgery; Sleep surgery; Surgery; Time Factors; Treatment Outcome; Operative Technique; Genioglossus advancement; Obstructive sleep apnea; Sleep surgery; Maxillomandibular advancement
• ISSN: 1010-5182; 1878-4119
• DOI: 10.1016/j.jcms.2015.05.015

Abstract Objective Obstructive sleep apnea (OSA) can be a challenging disorder to treat. Maxillomandibular advancements (MMAs) generally have high success rates; however, larger advancements have higher success and cure rates. Our aim is to present and to describe the current technique used by the senior authors, which has been successful for performing large advancements, thereby improving post-operative outcomes. Methods The senior authors have developed and modified their maxillomandibular advancement operative techniques significantly over the past 30 years. The current version of the Riley–Powell MMA technique is described in a step-by-step fashion in this article. Results Initially, as part of the MMAs, patients underwent maxillomandibular fixation with wires, lag screws and harvested split calvarial bone grafts. The current technique utilizes plates, screws, Erich Arch Bars, and suspension wires which are left in place for 5–6 weeks. Guiding elastics are worn for the first week. The MMA technique described in this article has yielded a success rate over 90% for patients with a body mass index (BMI) <40 kg/m2 and 81% for patients with a BMI ≥40 kg/m2. Conclusion Large advancements during maxillomandibular advancement surgeries can help improve post-operative obstructive sleep apnea outcomes.