ProceduresObstructive sleep apnoea · Maxillofacial

Sleep apnoea:
when the airway is about bone

In obstructive apnoea the airway closes during sleep. The first treatment is CPAP; when it is not tolerated or not enough, moving the jaws forward enlarges the airway from its structure.

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Diagnosis: Sleep study (polysomnography)
First line: CPAP
Surgery: In hospital, under general anesthesia
Planning: CT scan of the airway and jaws

Approximate values: every case is different and your plan confirms them at the consultation.

What is obstructive sleep apnoea?

During sleep the throat muscles relax. In obstructive apnoea the airway narrows or closes again and again: oxygen drops, sleep is interrupted, and snoring, tiredness and daytime sleepiness appear.

CPAP—a mask that keeps the airway open with pressurised air—is the first-line treatment. Sleep medicine guidelines recommend considering surgery for people who cannot tolerate or do not accept it.

Maxillomandibular advancement moves the upper and lower jaws forward, and with them the tongue and throat tissues: the airway widens along its whole length. In selected patients it is the surgery with the best results for apnoea.

Who is it considered for?

01Moderate or severe apnoeaconfirmed by a sleep study.
02You cannot tolerate CPAPor it does not work as it should.
03A small or set-back jawthat narrows the airway.
04With sleep medicineand, if relevant, ENT.

Apnoea is diagnosed by sleep medicine; surgery is one of the options in the plan.

Options

From the mask to surgery.

The choice depends on severity, anatomy and what each person tolerates.

01First line
CPAP
Pressurised air during sleep. Prescribed and adjusted by sleep medicine.
02Mild to moderate apnoea
Mandibular advancement device
A splint that holds the lower jaw forward while you sleep.
03Surgery
Maxillomandibular advancement
The upper and lower jaws are moved forward with planned bone cuts and fixed with titanium plates.
04Complementary
Chin advancement
Moves forward the point where the tongue attaches; sometimes combined with maxillomandibular advancement.

Step by step

From the sleep study to the follow-up study.

01Before
Sleep study
Polysomnography and assessment by sleep medicine.
02Consultation
Maxillofacial assessment
CT scan of the airway and jaws; we plan how far to advance.
03Day 0
Surgery
In hospital, under general anesthesia, with a short stay.
04Weeks 1–6
Recovery
Soft diet and check-ups; swelling goes down over the first weeks.
05Months
Follow-up sleep study
Polysomnography is repeated to measure the result.

After maxillomandibular advancement

What to expect

Days 1–3
Swelling peaks; short hospital stay.
Weeks 1–2
Liquid to soft diet; swelling starts to ease.
Weeks 2–6
Soft diet; gradual return to routine.
Months
Follow-up sleep study.

Do not wait

When to seek care promptly

Someone notices you stop breathing while asleep
You get sleepy while driving
You snore loudly and wake up choking

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Frequently asked

What patients ask before deciding.

In selected patients, maxillomandibular advancement greatly reduces apnoea and many stop using CPAP. The result is measured with a follow-up sleep study.

Sleep medicine, with polysomnography. The maxillofacial surgeon is involved when the shape of the jaws is part of the problem.

The profile moves forward; in people with a set-back jaw it usually looks more balanced. It is planned beforehand and discussed at the assessment.

In some cases, especially with a specific obstruction; ENT assesses it. Maxillomandibular advancement acts on the whole airway at once.

No. You can snore without apnoea; apnoea is confirmed with a sleep study.