Obstructive sleep apnea (OSA) is a potentially life-threatening sleep disorder characterized by repeated episodes of partial or complete blockage of the upper airway during sleep. This blockage usually occurs behind the tongue base (oro-hypopharynx) and the soft palate (velo-pharynx).1 Symptoms often include loud snoring, choking or gasping during sleep, and daytime hypersomnolence. OSA can significantly impair quality of life, leading to memory loss, irritability, depression, chronic fatigue, reduced cognitive function, decreased libido, and impaired concentration. Left untreated, OSA will worsen with age, weight gain, or both, and may cause fatal events like hypertension, stroke, myocardial infarction, anoxic seizure, or sudden death.2 The main treatment for OSA currently is continuous positive airway pressure, also known as CPAP, with pharmacological options being researched as alternatives. Mandibular advancement surgery is another treatment option for OSA that is uncommon but may be highly beneficial for certain patients.
Mandibular advancement surgery pulls forward the anterior pharyngeal tissues attached to the maxilla, mandible, and hyoid to enlarge the entire velo-oro-hypopharynx, as well as to enhance the neuromuscular tone of the pharyngeal dilator musculature via an extrapharyngeal operation. The procedure suspends the pharyngeal muscles in an anterior position and simultaneously increases tension in pharyngeal soft tissues, moving the upper and lower jaw forward to help open the airway by creating more breathing space and improving muscle tone in the throat.3 Unlike jaw surgeries such as telegnathic or orthognathic surgery, mandibular advancement surgery is specifically aimed at treating OSA because of its effects on all airway levels, from the nasal cavity to the hypopharynx. The procedure has success rates around 97.5%.3,4
The apnea-hypopnea index (AHI) is a key parameter in OSA research that measures the number of apneas (complete pauses in breathing) and hypopneas (partial reductions in airflow) that occur per hour of sleep. A 2016 meta-analysis pooled data from 518 unique patients undergoing mandibular advancement surgery. The average reduction in AHI was 47.8 events per hour, showing that it significantly improves sleep apnea severity. Among the full cohort, 85.5% achieved surgical success (which is defined as a patient experiencingover 50% AHI reduction and fewer than 20 events/hour) and 39% reached surgical cure (defined as fewer than 5 events/hour).5 Outcomes varied by baseline severity; patients with lower preoperative AHI levels were more likely to achieve both surgical success and cure. Multivariate analyses showed that lower preoperative AHI, younger age, and higher preoperative oxygen saturation were directly correlated with surgical success and cure. Preoperative AHI was the single factor consistently associated with surgical outcome and linearly correlated with other measures of OSA disease severity (oxygen saturation, BMI, Epworth Sleepiness Scale score, etc.). Overall, mandibular advancement surgery demonstrated consistent and substantial reductions in AHI, reinforcing its effectiveness as a treatment for OSA.5
OSA is a serious, progressive condition with a wide range of health and quality-of-life impacts, but it is highly treatable with the appropriate intervention. Mandibular advancement surgery offers a structural and lasting solution by directly addressing airway obstruction through jaw repositioning. Clinical outcomes, particularly improvements in AHI, strongly support its effectiveness, with high rates of both surgical success and cure,3 providing an option for those with moderate to severe OSA who are seeking lasting relief beyond non-surgical therapies.
References
- Kuna, Samuel T. “Pathophysiology of Upper Airway Closure During Sleep.” JAMA: The Journal of the American Medical Association, 266(10), 1991, 1384. https://doi.org/10.1001/jama.1991.03470100076036
- Basheda, Stephen G., and Joseph A. Golish. “Obstructive Sleep Apnea Syndrome: Clinical Research and Treatment Ed. by Christian Guilleminault and Markka Partinen.” Cleveland Clinic Journal of Medicine, 58(4), 1991, 364. https://www.ccjm.org/content/58/4/364.3
- Riley, Robert W., et al. “Obstructive Sleep Apnea Syndrome: A Review of 306 Consecutively Treated Surgical Patients.” Otolaryngology–Head and Neck Surgery, 108(2), 1993, 117–125. https://doi.org/10.1177/019459989310800203
- Hochban, Walter, et al. “Surgical Maxillofacial Treatment of Obstructive Sleep Apnea:” Plastic and Reconstructive Surgery, 99(3), 1997, 619–626. https://doi.org/10.1097/00006534-199703000-00002
- Zaghi, Soroush, et al. “Maxillomandibular Advancement for Treatment of Obstructive Sleep Apnea: A Meta-Analysis.” JAMA Otolaryngology–Head & Neck Surgery, 142(1), 2016, 58. https://doi.org/10.1001/jamaoto.2015.2678