Q: Dr. Eppley, Wondering if you do maxillomandibular advancements surgery for sleep apnea or know of any other plastic surgeons that are also dentists/oral surgeons that might do this procedure. Would prefer to have a oral surgeon that is also skilled as a plastic surgeon in hopes of having not only a successful surgery, but also a better cosmetic outcome. Thank you.
A: I do perform bimaxillary (maxillomandibular) advancements for obstructive sleep apnea. You are correct in that there can be a delicate balance between how much to move the face below the eyes forward and not so much that it creates facial disharmony. (resultant infraorbital-malar hypoplasia) As a general rule it is recommended to move the maxilla and mandible as far forward as possible. (usually about 10mms) But in some patients that may well create a ‘protruding lower face’ that is disproportionate to the natural facial appearance above it. This requires insightful planning beforehand based on the patient’s facial shape. Using computer imaging and VSP (virtual surgery planning) for the facial bones from the patient’s 3D CT scan, more thoughtful surgical planning can be done that takes into account both the functional and aesthetic needs of the patient.
Dr. Barry Eppley
Q: Dear Dr. Eppley, I am interested in getting jaw surgery for my sleep apnea. My lower jaw is short and my doctor tells me it is a likely cause of my sleep problems. I had a chin implant put in several years ago which made it look so much better but now I am interested in getting the whole jaw moved forward. I know that orthodontics will be be needed before the surgery. The orthodontist said a year of braces would be required and that he estimated 5 mm of advancement would be possible. He also said it was uncertain whether the advancement would open my airway, but the first surgeon I meet with seemed more optimistic. I was going to attempt the surgery anyway because it would be nice to fix the malocclusion even if the apneas do not completely disappear. Do you ever advance the upper jaw along with the lower to increase the total advancement? Breaking my upper jaw along with the lower does not sound pleasant, but I obviously want the surgery to work.
A: The causes of sleep apnea are numerous and a short lower jaw is but one of them. In cases of a really significant mandibular deficiency, such as 8 or 10mms, it would be fair to say that jaw advancement has a very high probability of reducing some of the symptoms of sleep apnea. Since yours is only about 5mms, I would not be as optimistic. It is true that upper and lower jaw advancements (bimaxillary surgery) would allow the lower jaw to be moved forward much further. (probably 10mms in your case) But you have to look at the impact of that procedure on your facial aesthetics as you don’t want to trade off one problem for another, even if it just is an aesthetic one. Another option with your mandibular advancement is to remove the chin implant and do a bony genioplasty advancement at the same time. This would not only maintain your jawline and facial profile aesthetics but doubles your changes of just lower jaw surgery alone helping your sleep apnea. As the chin comes forward, it brings the genioglossus muscle and tongue forward as well. As the jaw advancement has a similar effect, the synergism of the two procedures might just be what would significantly improve your sleep apnea.
Dr. Barry Eppley