Maxillomandibular Advancement Outcomes in Obstructive Sleep Apnea by Age and Gender

Maxillomandibular advancement (MMA) is the most effective surgical treatment for obstructive sleep apnea (OSA) after tracheotomy. However, the influence of patient characteristics such as age and gender on MMA outcomes remains understudied. This meta-analysis evaluates MMA outcomes stratified by age and gender.

A comprehensive literature search of CINAHL, Cochrane Library, PubMed, and Scopus was performed from inception through 2026. Studies reporting age- or gender-specific outcomes of MMA for adults with OSA were included.

Extracted data included cephalometric measurements, apnea-hypopnea index (AHI), Epworth Sleepiness Scale (ESS), SpO2 nadir (LSAT), surgical success, and cure rates. Meta-analysis was performed.

Thirty-six studies comprising 608 patients were included. MMA significantly improved AHI, ESS, and LSAT (p < 0.05), with no significant differences in improvement between males and females or across age groups. Mean maxillary/mandibular advancement was 9.7/11.7 mm in males and 9.2/10.6 mm in females. Surgical success and cure rates were comparable between genders (OR_success = 1.06 [95% CI 0.54-2.10]; OR_cure = 1.17 [95% CI 0.51-2.69]). Increasing age was associated with decreased surgical success and cure, although only the decline in odds of cure reached statistical significance (OR = 0.97 annually, p = 0.029).

Maxillomandibular advancement yields significant improvements in OSA outcomes regardless of age or gender. While outcomes are generally consistent across groups, clinicians should counsel older adults on the reduced likelihood of surgical cure.

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