title: Large maxillomandibular advancements for obstructive sleep apnea: An operative technique evolved over 30 years.
abstract: OBJECTIVE
  Obstructive sleep apnea (OSA) can be a challenging disorder to treat. Maxillomandibular advancements (MMAs) generally have high success rates; however, larger advancements have higher success and cure rates. Our aim is to present and to describe the current technique used by the senior authors, which has been successful for performing large advancements, thereby improving post-operative outcomes.
  
  
  METHODS
  The senior authors have developed and modified their maxillomandibular advancement operative techniques significantly over the past 30 years. The current version of the Riley-Powell MMA technique is described in a step-by-step fashion in this article.
  
  
  RESULTS
  Initially, as part of the MMAs, patients underwent maxillomandibular fixation with wires, lag screws and harvested split calvarial bone grafts. The current technique utilizes plates, screws, Erich Arch Bars, and suspension wires which are left in place for 5-6 weeks. Guiding elastics are worn for the first week. The MMA technique described in this article has yielded a success rate over 90% for patients with a body mass index (BMI) <40 kg/m(2) and 81% for patients with a BMI ≥40 kg/m(2).
  
  
  CONCLUSIONS
  Large advancements during maxillomandibular advancement surgeries can help improve post-operative obstructive sleep apnea outcomes.
authors.affiliation: Department of Otolaryngology, Division of Sleep Surgery and Medicine, 1 Jarrett White Road, Tripler Army Medical Center, HI 96859, USA; Department of Psychiatry and Behavioral Sciences, Division of Sleep Medicine, Stanford Hospital and Clinics, Redwood City, CA, USA. Electronic address: drcamachoent@yahoo.com.
authors.forename: Macario
authors.initials: M
authors.lastname: Camacho
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Sleep Surgery Division, Stanford University Medical Center, Stanford, CA, USA.
authors.forename: Stanley Yung
authors.initials: SY
authors.lastname: Liu
authors.affiliation: Department of Otorhinolaryngology/Sleep Medicine Centre - Hospital CUF, Porto, Portugal; CINTESIS - Centre for Research in Health Technologies and Information Systems, University of Porto, Porto, Portugal.
authors.forename: Victor
authors.initials: V
authors.lastname: Certal
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Sleep Surgery Division, Stanford University Medical Center, Stanford, CA, USA.
authors.forename: Robson
authors.initials: R
authors.lastname: Capasso
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Sleep Surgery Division, Stanford University Medical Center, Stanford, CA, USA.
authors.forename: Nelson B
authors.initials: NB
authors.lastname: Powell
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Sleep Surgery Division, Stanford University Medical Center, Stanford, CA, USA.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Riley
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery*; D019186:Mandibular Advancement / Q000379:methods*; D008437:Maxilla / Q000601:surgery*; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Genioglossus advancement; Maxillomandibular advancement; Obstructive sleep apnea; Operative Technique; Sleep surgery