Is Maxillomandibular Advancement Possible in Skeletal Class III Patients? A Scoping Review

Area of Science:

• Oral and Maxillofacial Surgery
• Sleep Medicine
• Orthodontics

Background:

• Skeletal Class III malocclusion with obstructive sleep apnea (OSA) presents unique challenges for surgical intervention.
• Maxillomandibular advancement (MMA) applications in this specific patient cohort are not extensively documented.
• Understanding variations in MMA techniques is crucial for optimizing treatment outcomes.

Purpose of the Study:

• To conduct a scoping review exploring different maxillomandibular advancement (MMA) techniques used in skeletal Class III patients diagnosed with obstructive sleep apnea (OSA).
• To analyze the reported outcomes and variations of these MMA techniques in this specific patient subgroup.
• To provide insights for individualized surgical planning based on craniofacial morphology and airway obstruction site.

Main Methods:

• A comprehensive literature search was performed across major databases (PubMed, Embase, Cochrane, LILACS) up to May 2025.
• Nine relevant studies meeting the inclusion criteria were selected for review.
• Data extraction focused on MMA technique variations, surgical outcomes, and patient-specific considerations.

Main Results:

• Three primary MMA variations were identified: bimaxillary advancement, maxillary advancement with mandibular auto-rotation, and maxillary advancement with mandibular setback.
• All identified MMA techniques demonstrated effectiveness in treating OSA, achieving at least a 50% reduction in the apnea-hypopnea index (AHI).
• Each technique presented distinct advantages and disadvantages concerning airway enlargement, invasiveness, and potential for facial aesthetic distortion.

Conclusions:

• Maxillomandibular advancement (MMA) is an effective treatment for obstructive sleep apnea (OSA) in skeletal Class III patients, with technique selection impacting outcomes.
• Individualized surgical planning is paramount, considering patient craniofacial characteristics, the location of airway obstruction, and aesthetic goals.
• A decision flowchart is proposed to guide the selection of appropriate MMA techniques for skeletal Class III patients with OSA.