UPPER AIRWAY CHANGES FOLLOWING MAXILLOMANDIBULAR ADVANCEMENT IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA: A LITERATURE REVIEW

Abstract

Obstructive sleep apnea (OSA) is a common yet underdiagnosed sleep-related breathing disorder. Maxillomandibular advancement (MMA) stands out as one of the most effective surgical options for patients who cannot tolerate or do not respond adequately to continuous positive airway pressure (CPAP) therapy or mandibular advancement devices. This article provides a narrative review of evidence indexed in PubMed regarding the morphological, volumetric, and functional changes in the upper airway following MMA in adults with OSA. A structured search of the PubMed database was conducted on October 13, 2026, yielding 29 unique records, 28 of which underwent analysis of their metadata and abstracts. The studies demonstrated a consistent increase in upper airway volume—with significant gains in the retropalatal and oropharyngeal regions—a reduction in pharyngeal length, an anterior displacement of the soft palate, tongue, and hyoid bone, and an improvement in aerodynamic parameters as shown in computational simulations. The magnitude of volumetric gain varied across studies, and its relationship with the reduction in the apnea-hypopnea index (AHI) was not strictly linear, with a potential plateau effect being described. Meta-analyses indicate surgical success rates of approximately 85% and cure rates near 40%, with facial paresthesia being the most frequent sequela. In conclusion, MMA facilitates a multilevel expansion of the upper airway, which is associated with improvements in polysomnographic findings; however, standardized prospective studies are still required to better tailor the magnitude of the advancement to the individual patient.