Maxillomandibular Advancement Surgery (MMA) Therapy
Sleep apnea is a disorder that effects about 22 million people throughout the United States. It causes patients to have up to 20-30 pauses in their breathing each hour when they are sleeping. Patients who suffer from sleep apnea have a lack of oxygen which alerts the brain. This alert causes patients to temporarily wake up in order to restart and correct their breathing. As a result of this process, people suffer from poor quality sleep and constantly feeling tired and groggy throughout the day.
It is common for obstructive sleep apnea to go undiagnosed as it is difficult for doctors to detect the condition during a routine office visit. There are also no blood tests which can aid in diagnosing the condition. The most common type of sleep apnea is called obstructive sleep apnea (OSA). With OSA, the airway collapses or is blocked while sleeping. This results in shallow breathing or pauses in breathing.
Another type of sleep apnea is central sleep apnea. Unlike OSA, the airway is not blocked, however, the brain does not signal the muscles to breathe as a result of the instability in the respiratory control center.
When it is left untreated, sleep apnea can increase a patient’s risk for numerous health issues. Some of these problems include the following:
- Heart failure, irregular heart beats, and heart attacks
- High blood pressure
- Worsening of ADHD
Maxillomandibular advancement surgery (MMA) is an effective treatment used for people who have obstructive sleep apnea (OSA). With MMA, the bones of the upper and lower jaw are repositioned in order to relieve the obstruction in the airway. The procedure works by suspending the attached pharyngeal airway muscles in an anterior position and simultaneously increasing the pharyngeal soft tissue tension.
In comparison to all the surgical procedures used to treat OSA, there are effects at all airway levels. These range from the nasal cavity to the hypopharynx. According to the Mayo Clinic, a vast majority of patients, even those who suffer from severe OSA, have a successful outcome after surgery. More than 50% of patients are able to eliminate obstructive sleep apnea altogether.
A popular thought is that MMA is reserved for patients with craniofacial dysmorphism or mandibular retrognathia. However, patients who have normal osseous structures, OSA in the context of excess soft tissue, including obesity, are often good surgical candidates and have the same positive outcomes.
Another though is that MMA is a "salvage" surgical option to be used only after the other soft tissue procedures, including uvulopalatopharyngoplasty (UPPP), have been attempted and failed. MMA is an excellent option for patients who have moderate to severe OSA and desire pursing a surgical solution.
In the craniofacial operation MMA, pre-surgical virtual scanning using 3-D imaging is executed in order to ensure precise accuracy and efficiency in the operating room. Following the operation, patients are often monitored overnight in an ICU setting. Most patients have inpatient hospital stay of 2-3 days.
The amount of pain experienced is usually less compared to the level of pain encountered with soft palatal procedures, such as UPPP. Upon discharge from the hospital, most patients are able to manage their pain using non-opioid analgesics. Manipulation of the facial sensory nerves during surgery results in paresthesia. This provides patients with a temporary reduction in their pain. Because current internal bone fixation devices used with MMA do not require the wiring of the jaw, patients can begin eating a soft mechanical diet immediately following the procedure.
Any changes in the facial appearance vary based on the preoperative anatomy and if the patient was obese. Studies demonstrate that about 70 percent of patients perceive an improvement in that their facial appearance after MMA. About 20-25 percent report virtually no change in their facial appearance. A long-term negative outcome is rare. The procedure must be considered the same as any other orthopedic surgeries, the final outcome and condition will take place in about 9-12 months.
The expected recovery process is approximately six weeks. Most patients can typically expect to have a gradual return to their normal work or school activities in about three weeks. Postoperative polysomnography is typically completed in about three months, once the soft tissue edema is resolved.
MMA is considered to be both an effective and safe treatment for OSA. Some of the benefits include improved breathing, more wakefulness during the day, and an overall improved quality of life as well as a reduced cardiovascular risk.
MMA is commonly considered the preferred treatment option for patients who have moderate to severe OSA and are unable to consistently use the continuous positive airway pressure (CPAP) treatment or those who decline CPAP as a long-term treatment.
A recent study was conducted which included 30 adult patients who experienced severe OSA. Most of the participants were overweight and male. The participants underwent MMA as a result of being unable to continue CPAP therapy or after declining the long0term use of the CPAP. CPAP, which is the standard accepted therapy for OSA, pushes air to maintain open airways. The collected data was recorded before and after MMA surgery.
Following MMA, patients experienced significant improvements in their sleep-disordered breathing, sleepiness, sleep-specific quality of life, general quality of life, and performance related to mental processes or neurocognitive performance in addition to lower blood pressure.
Almost 94% of the participants met normal levels of sleepiness following the surgery. There were minimal cases of adverse events associated with the treatment. The results were compatible to those reported in other studies which associate MMA with minimal major complications and limited treatment-related adverse events.
The researchers noted that this is the only multicenter prospective study which has comprehensively assessed the effectiveness and safety of MMA by measuring the subjective treatment-related symptoms in addition to the objective physical findings following surgery.
The researchers also reported that the results of the study demonstrate that patients had very few adverse treatment-related symptoms or abnormal physical findings following MMA, which minimally impacted their overall quality of life.
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