Surgical Planning for Management of Obstructive Sleep Apnea

Maxillomandibular advancement (MMA) is the most widely used and most effective surgical technique for the curative treatment of obstructive sleep apnea (OSA). Numerous tools evaluate airway structure and patency before and after surgery to confirm the reduction of apnea-hypopnea index (AHI), but no clear guidelines exist on how to plan this surgery. This study performs a systematic review of MMA planning for OSA among English-language literature from January 1989 to January 2025 to identify how surgeons determine the magnitude and method of MMA. Seventy-four articles with 2238 patients were accessed (mean age 42.3±11.2 y); 4 studies (N=289) performed staged surgical treatment, and 23 (N=403) reported ancillary procedures with the single-stage MMA. Rotational MMA was reported in 34 studies and has gained popularity in the past 2 decades, treating 73.6% of patients after 2015. Preoperative OSA severity did not differ between rotational and conventional MMA treatments (AHI rotational =47.9 [38.3, 59.3] versus AHI conventional =49.0 [43.5, 57.5]; P =0.661), and both therapies achieved postoperative AHI<10 with similar posterior airway space increases (4.69±4.55 mm versus 4.86±5.75 mm; P =0.543). MMA magnitude did not correlate with preoperative or postoperative. AHI values for either MMA technique. Anatomic landmarks for measuring advancement and definitions of airway boundaries varied widely between studies; point A (15/76) and point B (15/76) were the most common landmarks. We conclude that airway function is not incorporated into MMA planning for OSA and that inconsistent anatomic landmarks are used in current planning methods.