Maxillomandibular advancement for obstructive sleep apnea: a contemporary review

Obstructive sleep apnea (OSA) affects up to one billion adults worldwide and is associated with hypertension, cardiometabolic disease, neurocognitive decline, and increased all-cause mortality. While continuous positive airway pressure (CPAP) remains first-line therapy, more than half of patients are intolerant or non-adherent, leaving a substantial population at sustained risk. Maxillomandibular advancement (MMA) is one of the most effective surgical treatments for anatomically driven OSA to reconstruct a functional and patent airway, achieving approximately 80% reduction in the apnea-hypopnea index, durable improvements in nocturnal oxygenation, daytime function, and quality of life. Beyond standard apnea metrics, evidence links MMA-mediated correction of intermittent hypoxia to attenuation of oxidative stress, sympathetic hyperactivation, and cellular senescence pathways implicated in accelerated aging which positions MMA as a potentially disease-modifying intervention with implications for longevity. In this review, we synthesize the contemporary evidence on patient selection, surgical planning, magnitude of advancement, complications, and comparison with alternative therapies, and we identify key research gaps including the absence of long-term cardiovascular endpoints, head-to-head comparisons with hypoglossal nerve stimulation, and MMA-specific cost-effectiveness data. MMA should be considered not merely as craniofacial corrective surgery but as a definitive, healthspan-relevant treatment for selected patients with OSA.