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Surgical Planning for Management of Obstructive Sleep Apnea.

Isaac Mordukhovich1,2, Anthony DeLeonibus1, Ian Zelko1

  • 1Department of Plastic and Reconstructive Surgery.

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|December 15, 2025
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Summary

Maxillomandibular advancement (MMA) surgery effectively treats obstructive sleep apnea (OSA). However, current planning lacks standardized guidelines, relying on inconsistent anatomical landmarks and not incorporating airway function for optimal patient outcomes.

Keywords:
Maxillomandibular advancementobstructive sleep apneaorthognathic surgerysurgical planning

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Area of Science:

  • Oral and Maxillofacial Surgery
  • Sleep Medicine
  • Surgical Planning

Background:

  • Maxillomandibular advancement (MMA) is a leading surgical treatment for obstructive sleep apnea (OSA).
  • Despite its efficacy, clear guidelines for surgical planning, including determining advancement magnitude and surgical technique, are lacking.
  • Existing methods for evaluating airway structure and post-surgical outcomes do not fully inform surgical planning.

Purpose of the Study:

  • To systematically review current literature on maxillomandibular advancement (MMA) planning for obstructive sleep apnea (OSA).
  • To identify how surgeons determine the magnitude and method of MMA.
  • To assess the consistency of anatomical landmarks and the incorporation of airway function in surgical planning.

Main Methods:

  • Systematic review of English-language literature from January 1989 to January 2025.
  • Analysis of 74 articles involving 2238 patients undergoing MMA for OSA.
  • Examination of surgical techniques (conventional vs. rotational), ancillary procedures, and reported planning methods.

Main Results:

  • Rotational MMA has increased in popularity, accounting for 73.6% of cases after 2015.
  • Both rotational and conventional MMA achieved similar, significant improvements in postoperative apnea-hypopnea index (AHI) and posterior airway space.
  • MMA magnitude did not correlate with preoperative or postoperative AHI; planning relied on inconsistent anatomical landmarks, and airway function was not integrated.

Conclusions:

  • Current MMA planning for OSA lacks standardized guidelines and consistent use of anatomical landmarks.
  • Airway function is not systematically incorporated into the planning process for MMA surgery.
  • Further research is needed to develop evidence-based planning protocols for MMA to optimize OSA treatment outcomes.