Comments from the sleep surgeon
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Comments from the sleep surgeon

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Posted by sleepsurgeon on March 29, 2009 at 19:53:57:

Instead of answering questions within an existing thread, I've decided to start a new one because these comments are very important for people to understand. I am sure some will disagree with me and some may even cite articles that would dispute what I am going to say. I know this is going to sound quite a bit arrogant, but I can only say that no one has reviewed results of 600 pre- and post-MMA sleep studies or followed patients beyond 12 years from MMA...

Many people talk about the distance of advancement. I have always recommended maximizing the distance of advancement. There is good reason behind it. Maximizing the distance of advancement allows for enlargement of the airway as much as possible. My typical advancement for a man is about 14-15 mm at the osteotomy site (area of the bone cuts). Obviously, I have advanced some patients greater than that and some less. There is great difference depending on where you measure the distance, the incisor teeth, the molar teeth, on the dental cast, on the bony chin, on the soft tissue chin or on x-rays …etc. In general, a 14 mm advancement at the osteotomy site will give you a much more advancement if you measure it at the incisor teeth and an even greater advancement at the chin point especially when counter-clock rotation is done. I have seen patients for second opinion regarding persistent OSA following MMA and these patients were told that the jaws were advanced 10 or 12 mm. However, they were only 5-6 mm advancements at the osteotomy site. Again, if you are not advancing the jaws sufficiently, the success rate is going to be lower. It is certainly possible that good results can be achieved with small advancements such as 10 mm or less. However, the long-term result is going to be better when a larger advancement is done (one can only realize this when you follow your patients long-term).

So why the smaller advancements? Are there advantages? Definitely! It is easier, less work, and patients recover better, heal quicker. I will explain about it and much more on later posts.

Disclaimer, this shouldn't be taken as medical advice, such as that provided through a direct consultation and is not intended to replace it. The responses given are only educational and informative in nature and cannot in any way be used to represent a complete analysis or diagnosis. I cannot make recommendations regarding diagnosis and therapy. Those issues should be addressed directly with your health care practitioner.

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