Maxillomandibular advancement · New Jersey
Surgery for Obstructive Sleep Apnea
Jaw surgery that enlarges the airway itself, combined with nasal airway surgery when the nose is obstructed, for patients with obstructive sleep apnea who cannot use CPAP or want a long-term alternative to it. Each plan is designed for the airway and the face together.
Medically reviewed by Benjamin Subtelny, DDS, board-certified oral and maxillofacial surgeon
The airway
Why Jaw Position Matters
In obstructive sleep apnea, the airway behind the palate and tongue collapses during sleep and interrupts breathing many times an hour. CPAP works well when it is used, but many people cannot tolerate it. When the airway is narrowed by the position of the jaws, moving the jaws forward enlarges the airway at its source.
The nose is part of the airway too. A deviated septum or enlarged turbinates add resistance to every breath, so the nasal airway is examined at consultation and treated in the same operation when it is obstructed.
Procedures
The Operations
- Maxillomandibular Advancement (MMA)
- The upper and lower jaws are moved forward, each by an amount planned for the individual patient. The soft palate and tongue are attached to the jaws, so they move forward too, opening the airway at several levels at once. A 2025 review of 31 studies including 1,597 patients concluded that MMA “has the highest success rate for obstructive sleep apnea among current surgical treatments” (Walker et al., Otolaryngology–Head and Neck Surgery, 2025). In an earlier review of more than 500 patients, the average apnea-hypopnea index (AHI) fell from 57 to under 10 events per hour after MMA, and patients with the most severe sleep apnea tended to see the largest improvements. Daytime sleepiness scores fell by 76% on average, to well within the normal range (Zaghi et al., JAMA Otolaryngology, 2016).
- Genial Tubercle Advancement
- The part of the lower jaw where the main tongue muscle attaches, on the backside of the chin, is brought forward, pulling the base of the tongue away from the back of the throat.
- Nasal Airway Surgery With MMA
- When the nose is obstructed, septoplasty straightens the nasal septum and turbinate reduction opens the nasal passages, in the same operation as MMA. Better nasal breathing adds to the result.
Approach
Form Follows Function
Moving the jaws forward also changes the face. For most people with sleep apnea and retruded jaws, the result is a stronger chin, a sharpened jawline, a more defined neck, and better support for the lips. Bringing the jaws forward also gives the skin and soft tissues of the face more support, which helps to resist sagging with age.
Dr. Subtelny plans each movement to gain as much airway as possible while improving the balance and appearance of the face. You review the planned movements and how they are expected to change your profile with Dr. Subtelny before surgery.
Candidates
Who Is a Candidate
- Moderate to severe obstructive sleep apnea on a sleep study
- Unable to tolerate CPAP, or not improved by it
- Jaws that sit too far back or are too narrow, crowding the tongue and airway
- Sleep apnea that persists after prior surgeries
Coordination
Working With Your Sleep Physician
Surgery is planned from a recent sleep study, an examination of the nose, and the position and width of the jaws, which set the space available for the tongue and airway. A follow-up sleep study after healing confirms the result. Dr. Subtelny works alongside sleep physicians, ENT surgeons, and dentists who provide oral appliances, so each patient is matched to the right option, surgical or not.
Recovery
Recovery
Recovery is similar to double-jaw surgery: usually one night in the hospital, a non-chew diet followed by soft foods, and a return to most daily activities in three to four weeks. Swelling peaks in the first few days and fades over several weeks.
Questions
Common Questions
Will I still need CPAP after MMA?
Many patients no longer need CPAP after MMA. A sleep study after healing determines whether any further treatment is needed.
Will MMA change how I look?
Yes, and the change is planned. Most patients with retruded jaws find it an improvement, and you review the planned movements with Dr. Subtelny before surgery.
Is MMA covered by insurance?
It is often covered when sleep apnea is documented on a sleep study and CPAP has been tried, and nasal airway surgery performed with it is billed to the same plan. Our office prepares the documentation and requests prior authorization. Insurance and costs
Am I too old for jaw surgery?
Age alone is not a barrier. Overall health and the findings of the sleep study matter more.
Next step
Talk It Through in Person
Consultations in Paramus and Old Bridge, New Jersey. No referral is needed.