Facial surgery for obstructive sleep apnoea

Obstructive sleep apnoea (OSA) is a chronic condition where the walls of the throat relax and narrow during sleep, completely blocking the airway. Miss Francine Ryba, consultant oral and maxillofacial surgeon specialising in surgery of the mouth at Cleveland Clinic London Hospital, offers advanced structural interventions to physically expand the airway when standard treatments fail.

While continuous positive airway pressure (CPAP) machines remain the primary choice for management, surgical restructuring of the facial skeleton provides a permanent solution for patients with specific anatomical obstructions. This article outlines the surgical options available to correct the underlying structural causes. 

What is facial surgery for obstructive sleep apnoea?

Facial surgery for obstructive sleep apnoea involves repositioning the bones of the face and jaw to increase the space behind the tongue and soft palate. It’s a highly effective option for patients who cannot tolerate CPAP therapy or oral appliances, which accounts for approximately 30 to 40 per cent of users.

The most successful structural procedure is maxillomandibular advancement (MMA) surgery. This procedure physically moves both the upper and lower jaws forward, which pulls the attached soft tissues forward and permanently opens the breathing passage.

Clinical data shows that MMA surgery achieves a success rate of over 85 per cent in significantly reducing the number of airway blockages experienced during sleep.

When should a patient consider a surgical consultation?

A surgical consultation is recommended when a sleep study (polysomnography) confirms moderate to severe OSA, and conservative measures have failed to improve daytime sleepiness or reduce health risks. Structural surgery is particularly suited for individuals with a recessed jaw, a small lower airway, or a specific craniofacial restriction.

Left untreated, severe OSA increases the risk of cardiovascular issues, stroke, and chronic fatigue. Patients should seek a specialist oral and maxillofacial assessment if they struggle with CPAP compliance or if their jaw structure is the clear physical cause of their breathing obstruction.

What are the specific surgical techniques used?

The exact surgical approach is chosen based on a comprehensive analysis of the patient's airway anatomy using three-dimensional imaging. Precise maxillofacial procedures, designed to maximise airway volume while maintaining proper dental alignment and facial harmony, include:

• Maxillomandibular advancement: The surgical forward movement of the upper and lower jaws, which creates a larger breathing space throughout the entire upper airway.
• Genioglossus advancement: A targeted procedure that moves the front part of the chin bone forward, tightening the tendon of the tongue to prevent it from falling backward during sleep.
• Surgically assisted rapid palatal expansion: A method used to widen a narrow upper jaw, which improves nasal airflow and increases overall oral cavity volume.
• Bimaxillary osteotomy: A combined approach where the jaws are adjusted in multiple directions to correct complex bite issues alongside the airway obstruction.

What is the recovery process like after jaw surgery?

Recovery from major facial restructuring requires a dedicated period of healing, with most patients staying in hospital for one to two days post-surgery. Initial swelling and a restricted diet are necessary during the first few weeks while the facial bones begin to fuse in their new positions.

Research indicates that the long-term benefits include not only the resolution of sleep apnoea symptoms but also a permanent drop in blood pressure and an improved quality of life. Following a structured postoperative plan ensures that the bones heal strongly and the airway remains wide open for life.

References

• British Association of Oral and Maxillofacial Surgeons (BAOMS). (2024). Jaw Surgery for Sleep Apnoea: Patient Information.
• NHS England. (2023). National Clinical Pathway for Obstructive Sleep Apnoea.
• Sleep Medicine Reviews. (2022). Maxillomandibular Advancement for Obstructive Sleep Apnoea: A Systematic Review and Meta-Analysis.
• National Institute for Health and Care Excellence (NICE). (2021). Obstructive sleep apnoea/hypopnoea syndrome: assessment and management (NG202).