Maxillomandibular Advancement for Obstructive Sleep Apnea Syndrome: Long-Term Results of Respiratory Function and Reverse Face-Lift

Abstract

Purpose: Scientific literature considers maxillomandibular advancement (MMA) as the most effective surgical treatment for the management of adult obstructive sleep apnea syndrome (OSAS). Maxillomandibular advancement enlarges the pharyngeal space by expanding the skeletal framework. Moreover, it projects the soft tissue of the cheeks, the mouth, and the nose in the aging face, which is characterized by multiple signs affecting the middle third and the lower third. The potential of orthognathic surgery (double jaw surgical advancement) of expanding the skeletal foundation to increase the facial drape support and to rejuvenate the face by a "reverse face-lift" is now recognized. The aim of this study was to review the surgical outcomes after MMA in terms of respiratory function and assessment of facial esthetics. Methods: We retrospectively reviewed the charts of all patients affected by OSAS who underwent maxillomandibular advancement between January 2010 and December 2015 in 2 tertiary hospitals (IRCCS Policlinico San Martino of Genoa and IRCCS Policlinico Ca' Granda of Milan). During the postoperative follow-up examination, all patients underwent polysomnographic examination and esthetic assessment to evaluate the respiratory function and facial rejuvenation after double jaw surgical advancement. Results: The final study sample included 25 patients (5 females, 20 males). The overall success rate of the surgical treatment (apnea/hypopnea index, AHI < 20) was 79%; the overall rate of surgical cure (AHI < 5) was 47%. Twenty-three patients (92%) showed a degree of rejuvenation after MMA. Conclusions: Maxillomandibular advancement is currently the most effective surgical treatment for the management of OSAS in adult patients who are not responders to medical treatment. "Reverse face-lift" is the consequence of the double jaw surgical advancement.