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

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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.