Maxillomandibular Advancement
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Maxillomandibular Advancement
Maxillomandibular advancement (MMA) or orthognathic surgery, also sometimes called bimaxillary advancement (Bi-Max), or maxillomandibular osteotomy (MMO), is a surgical procedure or sleep surgery which moves the upper jaw (maxilla) and the lower jaw (mandible) forward. The procedure was first used to correct deformities of the facial skeleton to include malocclusion. In the late 1970s advancement of the lower jaw (mandibular advancement) was noted to improve sleepiness in three patients. Subsequently, maxillomandibular advancement was used for patients with obstructive sleep apnea. Currently, maxillomandibular advancement surgery is often performed simultaneously with genioglossus advancement (tongue advancement). The genioglossus advancement pulls the tongue forward in a manner that decreases the amount of tongue blockage during sleep. MMA has been demonstrated to be one of the most effective surgical treatments for sleep apnea, due to its high success rate. Nonetheless, the pr ...
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Orthognathic Surgery
Orthognathic surgery (), also known as corrective jaw surgery or simply jaw surgery, is surgery designed to correct conditions of the jaw and lower face related to structure, growth, airway issues including sleep apnea, TMJ disorders, malocclusion problems primarily arising from skeletal disharmonies, other orthodontic dental bite problems that cannot be easily treated with braces, as well as the broad range of facial imbalances, disharmonies, asymmetries and malproportions where correction can be considered to improve facial aesthetics and self esteem. The origins of orthognathic surgery belong in oral surgery, and the basic operations related to the surgical removal of impacted or displaced teeth – especially where indicated by orthodontics to enhance dental treatments of malocclusion and dental crowding. One of the first published cases of orthognathic surgery was the one from Dr. Simon P. Hullihen in 1849. Originally coined by Harold Hargis, it was more widely popularis ...
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Sleep Surgery
Sleep surgery is a surgery performed to treat sleep disordered breathing. Sleep disordered breathing is a spectrum of disorders that includes snoring, upper airway resistance syndrome, and obstructive sleep apnea. These surgeries are performed by surgeons trained in otolaryngology, oral maxillofacial surgery, and craniofacial surgery. Definitions Obstructive sleep apnea or sleep apnea is defined as either cessation of breathing (apnea) for 10 seconds, or a decrease in normal breathing (hypopnea) with an associated desaturation in oxygen and arousal during sleep that lasts at least 10 seconds. In adults, it is typical to have up to 4.9 events per hour. In obstructive sleep apnea, affected individuals are categorized based on how many apneas or hypopneas ( apnea-hypopnea index or AHI) or events they have per hour. * Normal: <5 events per hour * Mild: 5 to <15 events per hour * Moderate: 15 to 30 events per hour * Severe: >30 events per hour The Wisconsin Sleep Cohort Study, a
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Maxilla
The maxilla (plural: ''maxillae'' ) in vertebrates is the upper fixed (not fixed in Neopterygii) bone of the jaw formed from the fusion of two maxillary bones. In humans, the upper jaw includes the hard palate in the front of the mouth. The two maxillary bones are fused at the intermaxillary suture, forming the anterior nasal spine. This is similar to the mandible (lower jaw), which is also a fusion of two mandibular bones at the mandibular symphysis. The mandible is the movable part of the jaw. Structure In humans, the maxilla consists of: * The body of the maxilla * Four processes ** the zygomatic process ** the frontal process of maxilla ** the alveolar process ** the palatine process * three surfaces – anterior, posterior, medial * the Infraorbital foramen * the maxillary sinus * the incisive foramen Articulations Each maxilla articulates with nine bones: * two of the cranium: the frontal and ethmoid * seven of the face: the nasal, zygomatic, lacrimal ...
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Mandible
In anatomy, the mandible, lower jaw or jawbone is the largest, strongest and lowest bone in the human facial skeleton. It forms the lower jaw and holds the lower teeth in place. The mandible sits beneath the maxilla. It is the only movable bone of the skull (discounting the ossicles of the middle ear). It is connected to the temporal bones by the temporomandibular joints. The bone is formed in the fetus from a fusion of the left and right mandibular prominences, and the point where these sides join, the mandibular symphysis, is still visible as a faint ridge in the midline. Like other symphyses in the body, this is a midline articulation where the bones are joined by fibrocartilage, but this articulation fuses together in early childhood.Illustrated Anatomy of the Head and Neck, Fehrenbach and Herring, Elsevier, 2012, p. 59 The word "mandible" derives from the Latin word ''mandibula'', "jawbone" (literally "one used for chewing"), from '' mandere'' "to chew" and ''-bula'' (ins ...
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Malocclusion
In orthodontics, a malocclusion is a misalignment or incorrect relation between the teeth of the upper and lower dental arches when they approach each other as the jaws close. The English-language term dates from 1864; Edward Angle (1855-1930), the "father of modern orthodontics", popularised it. The word "malocclusion" derives from ''occlusion'', and refers to the manner in which opposing teeth meet ('' mal-'' + ''occlusion'' = "incorrect closure"). The malocclusion classification is based on the relationship of the mesiobuccal cusp of the maxillary first molar and the buccal groove of the mandibular first molar.  If this molar relationship exists, then the teeth can align into normal occlusion. According to Angle, malocclusion is any deviation of the occlusion from the ideal. However, assessment for malocclusion should also take into account aesthetics and the impact on functionality. If these aspects are acceptable to the patient despite meeting the formal definiti ...
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Obstructive Sleep Apnea
Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder and is characterized by recurrent episodes of complete or partial obstruction of the upper airway leading to reduced or absent breathing during sleep. These episodes are termed "apneas" with complete or near-complete cessation of breathing, or " hypopneas" when the reduction in breathing is partial. In either case, a fall in blood oxygen saturation, a disruption in sleep, or both may result. A high frequency of apneas or hypopneas during sleep may interfere with restorative sleep, whichin combination with disturbances in blood oxygenationis thought to contribute to negative consequences to health and quality of life. The terms obstructive sleep apnea syndrome (OSAS) or obstructive sleep apnea–hypopnea syndrome (OSAHS) may be used to refer to OSA when it is associated with symptoms during the daytime (e.g. excessive daytime sleepiness, decreased cognitive function). Most individuals with OSA are ...
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Genioglossus Advancement
Genioglossus advancement (GA), also known as genial tubercle advancement (GTA), is a surgical procedure or sleep surgery in which the base of the tongue is pulled forward, usually to increase airway size due to deformity or a sleep breathing disorder. This procedure is frequently performed with either uvulopalatopharyngoplasty Uvulopalatopharyngoplasty (also known by the abbreviations UPPP and UP3) is a surgical procedure or sleep surgery used to remove tissue and/or remodel tissue in the throat. This could be because of sleep issues. Tissues which may typically be remov ... or maxillomandibular advancement surgeries. Tongue muscles (genioglossus, geniohyoid and others) are attached to the lower jaw below the teeth. During a genioglossus advancement procedure, a small window or bone cut is made in the front part of the lower jaw (mandible) at the level of the geniotubercle which is where the genioglossus muscle is attached. This piece of bone along with the attachment for the ...
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Tonsillectomy
Tonsillectomy is a list of surgical procedures, surgical procedure in which both palatine tonsils are fully removed from the back of the throat. The procedure is mainly performed for recurrent tonsillitis, throat infections and obstructive sleep apnea (OSA). For those with frequent throat infections, surgery results in 0.6 (95% confidence interval: 1.0 to 0.1) fewer sore throats in the following year, but there is no evidence of long term benefits. In children with OSA it results in improved quality of life. While generally safe, complications may include bleeding, vomiting, dehydration, trouble eating, and trouble talking. Sore throat, Throat pain typically lasts about one to two weeks after surgery. Bleeding occurs in about 1% within the first day and another 2% after that. Death occurs as a result in between 1 out of 2,360 and 1 in 56,000 procedures. Tonsillectomy does not appear to affect long term Immune system, immune function. Following the surgery ibuprofen and paracet ...
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Uvulopalatopharyngoplasty
Uvulopalatopharyngoplasty (also known by the abbreviations UPPP and UP3) is a surgical procedure or sleep surgery used to remove tissue and/or remodel tissue in the throat. This could be because of sleep issues. Tissues which may typically be removed include: * The tonsils * The adenoids Tissues which may typically be remodeled include: * The uvula (see uvulotomy) * The soft palate * The pharynx Procedure UPPP involves removal of the tonsils, the posterior surface of the soft palate, and the uvula. The uvula is then folded toward the soft palate and sutured together as demonstrated in the figures. In the US, UPPP is the most commonly performed procedure for obstructive sleep apnea with approximately 33,000 procedures performed per year. The surgery is more successful in patients who are not obese, and there is a limited role in morbidly obese (>40 kg/m2) individuals. Procedural details Standard procedure UPPP is typically administered to patients with obstructive sl ...
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Jaw Surgery
Orthognathic surgery (), also known as corrective jaw surgery or simply jaw surgery, is surgery designed to correct conditions of the jaw and lower face related to structure, growth, airway issues including sleep apnea, TMJ disorders, malocclusion problems primarily arising from skeletal disharmonies, other orthodontic dental bite problems that cannot be easily treated with braces, as well as the broad range of facial imbalances, disharmonies, asymmetries and malproportions where correction can be considered to improve facial aesthetics and self esteem. The origins of orthognathic surgery belong in oral surgery, and the basic operations related to the surgical removal of impacted or displaced teeth – especially where indicated by orthodontics to enhance dental treatments of malocclusion and dental crowding. One of the first published cases of orthognathic surgery was the one from Dr. Simon P. Hullihen in 1849. Originally coined by Harold Hargis, it was more widely popularise ...
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