Sleep Apnea Timeline: Jaw Surgery (Maxillomandibular Advancement)

Maxillomandibular advancement moves both the upper and lower jaws forward, usually about 10 millimeters, which pulls the tongue and soft tissues forward and enlarges the whole airway. It is one of the most effective operations for sleep apnea, with a larger operation and a longer recovery than other surgery.

This page is one of seven treatment-track timelines for adult obstructive sleep apnea. The sleep study, how a track is chosen and how to read the outcomes row are covered on the sleep apnea treatment timelines page. Jaw surgery is also described on the sleep apnea and snoring treatments page.

Who follows this track

People with moderate or severe sleep apnea who could not use CPAP, especially those with a small or set-back jaw, those whose sleep apnea remained after soft-tissue throat surgery, and those who do not qualify for the Inspire implant, for example because of a circular pattern of collapse or a higher body mass index. The operation is done by an oral and maxillofacial surgeon, often working with the sleep physician and ENT surgeon.

Planning (months before surgery)

An evaluation by the oral and maxillofacial surgeon, with 3D imaging (CT), bite models and computer planning of the jaw movements. Some people need braces before surgery to line up the teeth, which can add many months; others go straight to surgery.

Surgery and recovery

• Surgery day: about 6 hours under general anesthesia. The upper and lower jaws are cut, moved forward and held with small titanium plates and screws, working through the mouth so there are no facial scars. The hospital stay averages about 3 to 4 days.

• Weeks 0 to 6: liquid, then soft diet while the bones heal. Facial swelling is greatest in the first days and fades over weeks.

• Weeks 2 to 10: return to usual daily activities and work.

• Months 3 to 6: a sleep study shows the result.

• Months 6 to 12: braces are finished if needed.

Side effects and complications

• Numbness of the lower lip and chin is very common at first (more than 8 in 10). It improves over months: about two-thirds still notice some numbness before 1 year and about one-third after 1 year, usually mild.

• Plates or screws are later removed in about 1 in 5, and infection after surgery occurs in about 1 in 6.

• Major complications are uncommon, about 1 to 3 percent.

• Other effects include a change in the bite, some relapse of the forward movement, and a change in facial appearance (a fuller profile), which surgical planning aims to keep pleasing. About 1 in 5 later have nasal surgery.

Outcomes on this track

• Breathing (AHI): across hundreds of patients, the AHI fell from about 57 to 9.5 (an 80 percent drop) in one analysis, and from 64 to 9.5 in another, with the lowest oxygen level rising from about 72 to 88 percent.

• Success: about 86 percent met the surgical success definition, and about 4 in 10 reached an AHI under 5. A starting AHI under 60, younger age and lower weight made a cure more likely. Compared with multilevel soft-tissue surgery, success was 85 versus 65 percent.

• Sleepiness: the Epworth score fell from about 13.5 to 3.2.

• Daily life: in one series, 93 percent reached a normal FOSQ score, and most people report satisfaction.

• Over time: the AHI was about 8 at 1 to 4 years and 4 to 8 years after surgery, but averaged 23 in people followed 8 years or more, so long-term retesting matters.

"Success" means the AHI fell by at least half and to below 20. These are averages from groups of people, not a prediction for any one person.

Check-ups and long-term care

• Frequent visits during the first 6 weeks, a sleep study 3 to 6 months after surgery, then yearly.

• Bite checks, and orthodontic finishing for some.

• A repeat sleep study if snoring or sleepiness return or weight changes.