What Maxillomandibular Advancement Is
Maxillomandibular advancement, or MMA, is jaw surgery for obstructive sleep apnea (OSA). The surgeon cuts and moves the upper jaw (maxilla) and the lower jaw (mandible) forward, then fixes them in the new position with small plates and screws. The muscles and soft tissues attached to the jaws are pulled forward too. That opens the space behind the tongue and soft palate, where the airway collapses during sleep.[7][8]
MMA is different from oral appliance therapy. An oral appliance holds the lower jaw forward only while you sleep. MMA changes the bone position for good. If you are still deciding among options, start with our guide to dental treatment for sleep apnea and our overview of oral surgery for sleep apnea, which covers the wider range of operations. This page focuses on MMA alone.
This page is for adults who have been diagnosed with OSA by a physician. It is not a substitute for advice from your sleep physician and surgeon.
Who Is a Candidate for MMA
OSA is diagnosed by a physician after a sleep study, either in a sleep lab or at home. Surgery is never the first step. The American Academy of Sleep Medicine (AASM) practice parameters say the presence and severity of OSA must be confirmed before any surgery, and that you should be told about alternatives such as CPAP and oral appliances, including how well they work.[5]
The same AASM parameters list MMA as an option for severe OSA in people who cannot tolerate CPAP or will not use it, or for people who tried an oral appliance and found it ineffective or unacceptable. Oral appliances are described as more often appropriate for mild and moderate OSA.[5] A later AASM review found that upper airway surgery, used as a rescue therapy, lowered sleepiness, snoring, blood pressure, and AHI in adults who could not accept CPAP.[6]
- You have a confirmed OSA diagnosis, most often moderate to severe.
- You could not tolerate CPAP, or CPAP did not control your OSA, and an oral appliance was not enough or was not a fit.
- You are healthy enough for general anesthesia and a hospital stay.
- Your jaw and airway anatomy suggest the surgery could help. Your surgeon checks this with an exam and imaging.
- You understand that the operation is major and that your bite and face can change.
How Insurers Often Screen for It
Medical plans usually set their own rules. As one example, one large insurer's published policy asks for a documented AHI or RDI of at least 15 (or 5 to 14 with symptoms or related health problems), a documented CPAP failure or intolerance, and a prior failed surgery in most cases. It makes an exception for people with certain jaw structure problems such as a small or set-back jaw.[10] Other plans differ. Ask yours for its written criteria before you schedule a consult.
What Happens Before, During, and After Surgery
Every surgeon has a slightly different process, so treat this as a general outline and ask your own team for details.
Planning and orthodontics
Planning usually starts with a sleep physician's report, imaging of the jaws and airway, and a bite exam. Many jaw surgery patients also work with an orthodontist. AAOMS notes that jaw surgery treatment "will probably include orthodontics before and after surgery" and is "a process rather than a single event."[8] Ask your surgeon whether your case needs braces and for how long.
The operation
MMA is done in a hospital or surgical center under general anesthesia. The surgeon makes cuts in the upper and lower jawbones, slides both forward, and secures them with plates and screws.[7][8] How far the jaws move depends on your anatomy and your surgical plan. Because the jaws move forward, your facial profile can change. Ask to see the planned changes before you decide.
Recovery
You will have swelling and discomfort after surgery, and your surgeon will give you detailed instructions for diet, activity, mouth care, and follow-up.[8] A hospital stay is usual, and how long depends on the surgeon and your health. One meta-analysis found that a higher body mass index (BMI) before surgery was associated with a longer hospital stay, although that link did not reach statistical significance.[2]
Plan for time away from work and normal routines. Your surgeon can tell you what to expect for your case. Follow-up sleep testing is how you learn whether the surgery worked, so ask when it will be done.
How Well Does MMA Work
MMA has some of the strongest results of any sleep apnea surgery, but the studies have limits. Most are case series without a control group, and many patients in them had already tried other treatments.
Results in the first years
A 2016 meta-analysis pooled data from 45 studies and 518 patients. On average, AHI fell by about 80 percent. Surgical success (AHI cut by more than half and under 20 events per hour) was 85.5 percent, and cure (AHI under 5) was 38.5 percent. Sleepiness scores dropped from 13.5 to 3.2 on average, and the lowest oxygen level during sleep rose from about 70 percent to 87 percent.[1] A starting AHI under 60 was the factor most strongly linked to cure.[1]
A 2025 meta-analysis of 31 studies and 1,597 patients found an average AHI drop of about 42 events per hour and concluded that MMA has the highest success rate among current surgical options for OSA.[2] A 2021 comparison with multilevel soft tissue surgery found pooled success and cure rates for MMA of 85.0 and 46.3 percent, compared with 65.1 and 28.1 percent for multilevel surgery. The authors noted that MMA had a higher complication rate.[4]
Results over many years
A 2019 meta-analysis looked at longer follow-up in a small number of studies. In the 4 to under 8 year group (54 patients), average AHI fell from 65.8 to 7.7. In the 8 years or longer group (35 patients), average AHI went from 53.2 to 23.1, which is moderate OSA. The authors said sleepiness and oxygen improvements held up, but that firm conclusions cannot be drawn from so few patients.[3] Weight gain, aging, and other factors can bring OSA back, so long-term follow-up matters.
Risks and Side Effects
MMA is major surgery. Risks include the general risks of anesthesia and surgery, plus problems specific to the jaws.
The 2025 meta-analysis reported that early lower-face numbness affected about 83 percent of patients. About 67 percent still had some numbness before the one-year mark, and about 33 percent after one year. Hardware removal was needed in about 22 percent. The authors reported no major complications or deaths in the studies they pooled, and concluded that most side effects were temporary.[2] The 2021 comparison reported a major complication rate of 3.2 percent for MMA.[4] Numbers differ by study, surgeon, and patient.
The AASM's review of very limited evidence found no clinically significant increase in serious lasting adverse events from upper airway surgery overall.[6] Other topics to ask about include changes in your bite, facial appearance, dental work needs, and the chance that OSA remains or returns.
- Numbness or tingling in the lower lip, chin, or cheeks
- Swelling, pain, and a period of diet restrictions
- Plates or screws that need to be removed later
- Changes in bite or facial profile
- Residual OSA, which may need CPAP or another treatment afterward
Cost and Insurance
There is no single price for MMA. The total includes the surgeon's fee, anesthesia, the hospital or surgical center, imaging, and any orthodontic care. It varies widely by location, facility, and how complex your case is. Ask your surgeon's office for a written estimate of each part.
Because OSA is a medical condition, MMA is generally billed to medical insurance, not dental insurance. Some plans require prior authorization and proof that CPAP and other treatments were tried, as one large insurer's policy does.[10] Ask your plan what documents it needs, and ask the surgeon's office to handle the authorization if they offer that service.
The Oral and Maxillofacial Surgeon's Role
Oral and maxillofacial surgery is a recognized dental specialty. An oral and maxillofacial surgeon is trained in surgery of the jaws, face, and mouth. AAOMS says these surgeons perform MMA and work with sleep medicine specialists, ear, nose, and throat doctors (otolaryngologists), pulmonologists, and general dentists to provide OSA care.[7] Other surgeons, including some ear, nose, and throat surgeons, also perform sleep surgery, so ask any surgeon how many MMA operations they do each year and what their results have been.
Your care team should also include a sleep physician who confirms the diagnosis and repeats a sleep study after recovery. Some people also work with a dentist who provides oral appliance therapy before surgery, since an appliance trial is often expected first.[5][9]
Next Steps and Finding a Provider
Start with a diagnosis. If you suspect sleep apnea, talk to your physician about a sleep study. If you already have a diagnosis and CPAP has not worked, ask about an oral appliance trial and about a surgical consultation. To look for an oral and maxillofacial surgeon or a dentist who provides oral appliance therapy near you, use our provider directory. Ask each provider about their training, how many patients they treat for OSA, and how they coordinate with your sleep physician. Browse our list of dentists who provide oral appliance therapy, grouped by state.
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