MMA Surgery for Sleep Apnea

MMA Surgery for Sleep Apnea

MMA Surgery for Sleep Apnea

by Dr. Scott Bolding

Table of Contents

01. What is MMA Surgery?

02. When is MMA Surgery Necessary?

03. How Issues in the Jaw Can Cause Sleep Apnea?

04. What Are the Potential Side Effects Associated with MMA Surgery?

05. An MMA Success Story

Treating obstructive sleep apnea (OSA)  is important for both mental and physical health. Sleep apnea can lead to other more serious issues such as stroke, heart attack, and dementia. The daytime sleepiness caused by sleep apnea also puts you at a greater risk of getting in a car wreck or other types of accidents. CPAP and oral appliances are often the first line of defense for OSA. But, these treatments don’t always work for everyone. For these patients, there are other options, namely surgery. There are many different types of surgeries for OSA. Each type deals with a different aspect of the airway. So the right procedure for you will depend on a thorough diagnosis. One of the most common surgeries to treat sleep apnea is MMA surgery. 
TMJ Disorders and Arthritis PRECiDENT Center for Facial and Dental Medicine

Let's Get Back to Normal.

It’s time to get the sleep you deserve. You don’t have to keep on living with the constant daytime sleepiness and other effects of sleep apnea. Schedule a consultation with our sleep apnea specialists today and start getting your life back.

What is MMA Surgery?

MMA is short for maxillomandibular advancement. During this procedure, the upper and lower jaws are moved forward, which enlarges the airway. MMA surgery is one of the most common and effective surgical procedures for treating obstructive sleep apnea.

We perform MMA surgery in an operating room under general anesthesia. After we make incisions inside the mouth and cheeks, the jaws are freed and moved forward.  Titanium plates and screws hold the jaws in place. Then we place large braces on your teeth. These braces are left on for about 6 weeks to help with healing and alignment. Rubber bands are also used to assist in maintaining a stable bite while your jaws heal.

This jaw surgery is one of the most effective procedures for treating OSA. in fact, it has a success rate of 90%. Most patients see a significant change in their AHI (number of apnea episodes). Many are able to go on sleeping without a CPAP or other device.

When is MMA Surgery Necessary?

MMA surgery is performed on patients who cannot tolerate CPAP and whose sleep apnea is caused by issues with their jaws. These issues can include underdeveloped jaws and TMJ disorders.

When we treat sleep apnea, our goal is to treat the underlying cause of the condition and cure the condition. If we do not cure the underlying cause, then we end up managing symptoms instead of solving the problem. The goal is always to help you find permanent relief.

One of the most common treatment options is the CPAP machine. CPAP uses pressurized air to keep your airway open while you sleep. Even though this device is often effective in treating OSA, it doesn’t always work for everyone. Most patients have a hard time using CPAP long-term. And it really only helps in managing sleep apnea instead of treating it. Surgical procedures like MMA can help patients find relief.

How Issues in the Jaw Can Cause Sleep Apnea?

The truth is sleep apnea is often caused by underlying issues in your airway, including the jaw.

If your jaw didn’t grow properly when you were a child, then it can affect the size of your airway. When your jaws are too small it puts you at a greater risk of developing sleep apnea. For example, if your lower jaw is too small it can cause your tongue to fall back into the airway when you’re sleeping. TMJ disorders can also cause sleep apnea. The damage done to the ligaments and tendons in your jaw joints can cause the jaw to fall back as you sleep, restricting your airway.       

The solution to these issues is to move the jaw forward, using MMA surgery.

What Are the Potential Side Effects Associated with MMA Surgery?

Any surgical procedure comes with risks, including MMA surgery. Some risks are common with any type of surgery, including bleeding and infections. We take precautions to reduce these risks, however. If you’re getting any kind of surgery stop taking aspirin, ibuprofen, vitamins, and herbal supplements before and after surgery to prevent bleeding. Infections are often prevented by taking antibiotics and maintaining proper hygiene after surgery.

Side Effects Unique to MMA Surgery:

  • Tooth injury
  • Change in your bite
  • Change in appearance
  • Weakening of upper and lower jawbone

Numbness in your teeth or other parts of your face is also a possibility. Incisions made around your jaw are near nerves that provide sensation to your teeth and face. Numbness in your face can also be caused by the swelling or stretching of the nerves in the surrounding area. In both cases, this numbness is often temporary and will resolve over time. Damaged nerves will grow back.

The swelling that occurs after surgery can also restrict the airway temporarily. This may make it harder to breathe immediately after surgery. But once the swelling goes down your breathing should improve. Swallowing may also be difficult for a little while because your body has to get used to the bigger space in your throat created by moving the jaws. Again, this will be temporary.

What Does Recovery Look Like?

After surgery, you will stay at least one night in the hospital. There you will be monitored to make sure the surgery was successful.

Even though MMA surgery is the most effective procedure, it is also very invasive. This means the recovery time will be longer than other procedures. The typical recovery time for MMA surgery is 6+ weeks. Over the course of that 6 weeks, you will be able to return to your normal life, including school and work. However, it is always recommended that this process is gradual so that healing can take place.

During your recovery time, you will experience some pain. Pain medication will be prescribed for you to take as needed. Again, we stress the importance of avoiding aspirin or ibuprofen immediately after surgery as they can lead to excessive bleeding, which can be life-threatening. Sucking on ice can also help reduce pain and swelling, like putting an ice pack on an injured knee or ankle.

Your diet will consist of a liquid-only diet for the first couple of weeks. We encourage you to drink liquids like milk, protein shakes, and juice along with water. Fat and protein are important to the healing process and will give you energy during your recovery. After several weeks you will be able to transition into a soft food diet, which can include things like:

  • Eggs
  • Potatoes
  • Rice

Finally, you will also be prescribed nasal saline and a nasal decongestant to use during this time. The saline washes away loose debris, like dried blood, and maintains moisture in your nose, which helps your body heal. The nasal decongestant decreases swelling in your nose and keeps the nasal passages open so you can breathe. The decongestant will primarily be used in the hospital because using it for too long can cause other problems.

An MMA Success Story

Tampa resident Heath Key is one of the many patients who have found relief through MMA surgery. As an executive at Tyson Foods, Heath knew he needed to do something about his sleep apnea when he noticed how it was affecting his performance at work.

At first, Heath’s doctor suggested a CPAP machine. However, Heath wanted to know if there were other options. And his search led him to PRECiDENT Center for Facial and Dental Medicine in St. Petersburg, Florida. Here he learned that the primary cause of his sleep apnea was an underdeveloped jaw. And after weighing all his options, Heath decided to move forward with MMA surgery.

MMA surgery ultimately gave Heath the results he was looking for.

Immediately after the surgery, you’re breathing better. You’re breathing like you haven’t breathed in years. I slept in a hospital like I haven’t slept in years. And I’ve slept at home every single day since then.

MMA Surgery Can Help You Breathe Again

Dealing with obstructive sleep apnea can be frustrating. But the tiredness you feel every day doesn’t have to go on forever. And the CPAP is not the only option for treatment. If you are having a hard time adjusting to the CPAP and want to get past simply managing your OSA, it may be time to consider other options, including MMA surgery. If the root cause of your sleep apnea is an issue with your jaw, MMA surgery will make it possible for you to breathe on your own again. 

If you are ready to take that step, our surgeons are ready to take it with you.

Accuracy of haptic robotic guidance of dental implant surgery for completely edentulous arches

Accuracy of haptic robotic guidance of dental implant surgery for completely edentulous arches

Scotty L. Bolding, DDS, MS, FACSa and Uday N. Reebye, MD, DMD

Three-dimensional (3D) im- aging with the use of cone beam computed tomography (CBCT) scanning and 3D im- age manipulation and plan- ning software programs have become popular.1 Utilizing these technologies has allowed the dental and surgical teams to plan complex surgeries virtually and has enabled guided tools to assist with the surgical placement of endos- teal dental implants. Three types of guided implant sur- geries have emerged from 3D imaging and planning tech- nology: physical static guides, camera-based navigation, and most recently robotic guidance.

Read this full article

Robotic-Guided Dental Implant Placement in Fully Edentulous Patients

Robotic-Guided Dental Implant Placement in Fully Edentulous Patients

Preliminary Results of a Prospective Multi-Center Clinical Study

Digital workflows have improved dental implant placement accuracy and precision in fully edentulous patients with a goal of predictable restorations. Despite the introduction of CBCT-based planning software and fabricated surgical guides, challenges remain in efficiently and accurately transferring the plans at surgery. Limitations inherent in the static guide workflow include treatment delays related to guide fabrication, the risk of poorly fitting guides, and the physical bulk of the guide impeding surgical site access and visualization. Robotic guidance using haptic boundaries has been well-documented to enhance accuracy, precision, and flexibility across surgical fields.1 Recently, robotic haptic guidance with the novel Yomi platform (Neocis Inc., Miami, FL) has shown promise in partially edentulous patients.2 This study aimed to evaluate the platform in fully edentulous patients. In a preliminary subset of a prospective single-arm clinical study, 8 patients who qualified for and elected to have dental implants to restore full-arch dentition were treated using Yomi robotic guidance. A virtual preoperative restorative and surgical plan was created on Yomi Plan software (Neocis Inc., Miami, FL) prior to surgery. On the day of surgery, the Yomi edentulous patient splint was affixed to the anterior maxilla or mandible using self-tapping bone screws. A patient CBCT scan with a splint-mounted fiducial array was obtained and merged with the previously created virtual plan. The fiducial array was replaced with a patient tracker end effector allowing Yomi to track patient motion. Intraoperatively, the surgeons maneuvered a handpiece attached to the Yomi robotic guidance arm, which haptically constrained osteotomies and implant placement to the virtual plan. Splint affixation proceeded under local anesthesia and the implant procedure under either local or general anesthesia. Intraoperative outcomes captured included safety, efficacy, surgical time, and a Likert scale evaluation of user experience. A total of 58 implants were placed in 11 arches in 8 patients. Thirty-five implants were placed in the mandible and 23 in the maxilla, including 3 dual-arch cases. Eight patients were edentulated during surgery. Bone quality ranged from poor to very dense. Yomi edentulous patient splint affixation and removal times averaged 6.5 ± 3.9 and 1.1 ± 0.3 minutes, respectively. Surgical time per arch averaged 20.5 ± 10.3 minutes for osteotomies and 9.9 ± 7.9 minutes for implant placement. Three arches were considered candidates for and were treated using a flapless approach, and conservative tissue flaps were performed in all other cases. Two patients had been considered candidates for and were successfully provided with immediately loaded full-arch prostheses. No adverse events were reported, and user experience was rated highly with respect to the standard of care. First cases using Yomi robotic guidance in fully edentulous patients were notable for brief procedural times, compatibility with minimally invasive soft tissue management and access to immediate loading of restorations for candidate patients. These results may attest to quick integration of the Yomi edentulous protocol into the digital practitioner’s clinical workflow and the ease of employing robotic guidance to enhance edentulous patient treatment. Additionally, there was no wait for surgical guide fabrication and no physical guide impeding access or visualization. Robotic haptic guidance securely constrained the handpiece to the virtual restorative plan. Given the accuracy, precision, and intraoperative flexibility of robotic surgical platforms, these preliminary data support the promise of Yomi robotic guidance to augment dental implant therapy for fully edentulous arches. This study was approved by WIRB and the FDA as G190282 Edentulous Patient Splint.

Figure thumbnail fx1

The Yomi edentulous patient splint was affixed anterior to the maxilla or mandible using self-tapping bone screws and intraoperatively connected to a patient tracker end effector, allowing the robotic system to track patient motion.

Figure thumbnail fx2

The surgeons maneuvered a handpiece attached to the Yomi robotic guidance arm, which haptically constrained motion to the virtual plan. Full-arch osteotomies and dental implant placement proceeded under haptic guidance.

Figure thumbnail fx3

Two patients had been considered candidates for and were successfully provided with immediately loaded full-arch prostheses. Successful early incorporation of immediately loaded prostheses indicates the ease with which robotic guidance may be employed to enhance restorative-driven protocols.