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Sleep Surgeon Question 50

Question 50 - What are the odds of a MMA relapse?

From: Bill B.

Dear Doctor:

I have with pleasure been reading your answers and sleepnet's postings . You are obviously a highly skilled surgeon in MMA and so many patients on sleepnet praise you. However, one question is not on "ask a sleep surgeon" that I think is important.

It is a problem with many surgeon that do jaw advancement and that is relapse. I can see you do a ton of MMAs 600 + and rotations 100+ were the lower jaw goes out futher than the upper jaw.

I know some surgeons have different techiques for MMA surgery and some are better than others in MMA.

Surgeon I have talked to talked about relapse.

I have two concerns regarding your relapse rate some surgeons have said the following:

1) A large advancement means more relapse of the jaws. One surgeon said anything advancement over 7 MM is bad because of relapse.

2) Also I was told there is a very high relapse rate in rotation of the jaw and advancement of the jaws were the lower jaw goes out more and most surgeons do not do it for reasons like this. You wrote you have done 100 + of them. These other surgeons are making me afraid of the rotation techique which I want. But I see nobody complaining about it on sleepnet when you do it.

Regarding relapse could you give me your approximate relapse rate in percnet terms or another way if more approprate of the above 2 relapse concerns of mine.

Additionally, other surgeons say rotation where the lower jaw goes out futher is not stable (what ever that means). Could you give me ane idea how stable your are say in percent terms or another way if more approprate and what the risk are of not being stable.

Thank you in advance,

Bill

Response Provided by Dr. Kasey Li
Jan. 31, 2009

Surgical relapse following jaw surgery was a major concern in the past when the bones were "fixed" using stainless wires. Additional stability was provided by "wiring the jaws shut". Clearly, this method of fixation was quite unstable and in my opinion, nearly 100% of the jaw surgery in the "old days" had some relapse due to muscel pull. Today, the use of rigid fixation with titanium plates and screws (same as dental implant material) has greatly reduce the concern of relapse. This method allows me to avoid "wire the jaws shut" (I have not done that in 15 years).

There are other factors that influence the stability of the operation. The distance of advancement, the rotation of the jaws and poor bone quality are factors that can increase the risk of relapse. However, increased risk does not mean that it will happen. How the operation was performed, how the fixation was applied, how the bone was adapted, and the use of additional fixation devices can increase the stability of the fixation and reduce the risk of relapse. It is really too technical to go into how relapse can occur and what can be done to minimize relapse.

Frankly, the fear of relapse does not even enter my mind as it just has not been a problem for me. I am not saying that it has not happend (relapse typically manifests as significant shift of the bite following surgery), but it clearly has been rare incidences. The 600+ MMA are simply for sleep apnea treatment and I have done many more jaw surgery for non-sleep apnea reasons and have utilized the same techniques. I absolutely DISAGREE that relapse is a problem in large advancements or anything beyond 7mm is bad. Actually, I wouldn't recommend even doing the operation with small advancements for sleep apnea (<10-12mm) since the improvement on the airway is not going to be worthwhile.

Kasey Li, MD