All about Maxillomandibular advancement surgery (MMA) itt

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Title:

the procedure:

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https://www.youtube.com/watch?v=5RLUYeY3Hlo

MMA is mostly performed to cure sleep apnea (most efficent method for that) and not for aesthetics reasons. nevertheless the procedure changes the appearance of the face immensely and can increase the facial aesthetics drastically.



surgeons distinguishes between straight maxillomandibular advancement (S-MMA) clockwise (CW-MMA) and counterclockwise maxillomandibular advancement (CCW-MMA). the (C)CW-MMA seems to deliever aesthetical more appealing results.

although MMA is a highly invasive surgery the complication rate seems to be acceptable

Complications/adverse effects of maxillomandibular advancement for the treatment of OSA in regard to outcome.


Abstract
OBJECTIVE:

To evaluate adverse effects/postoperative complications and surgical response rate of maxillomandibular advancement for the treatment of severe obstructive sleep apnea syndrome.
STUDY DESIGN:

Case series with chart review.
SETTING:

Otolaryngology Head and Neck Surgery Department in a teaching hospital.
SUBJECTS AND METHODS:

A total of 59 consecutive severe sleep apnea patients underwent maxillomandibular advancement. Systemic complications were evaluated from medical charts. Functional adverse effects and cosmetic consequences were evaluated by questionnaires. The treatment outcome was assessed by polysomnography.
RESULTS:

Fifty patients were evaluated. They had a mean age of 46.4 +/- 9.0 years. No serious postoperative complication was observed. The most frequent local complication was mental nerve sensory loss. Most patients reported cosmetic changes. The mean apnea-hypopnea index decreased from 65.5 +/- 26.7 per hour to 14.4 +/- 14.5 per hour (P < 0.0001). Light-sleep stages were also decreased (P < 0.0001), whereas deep-sleep stages were increased (P < 0.001).
CONCLUSION:

Maxillomandibular advancement can induce local adverse effects and cosmetic changes, but they seem to be considered as secondary to the patients according to the surgical outcome.

http://www.ncbi.nlm.nih.gov/pubmed/19861196

However MMA seems to affect the health of the jaw joint negatively
http://chirurgiaestetica.forumcommunity.net/?t=57571868

the recovery after surgery is about three month
http://sleepdisorders.about.com/od/sleepdisorderstreatment/a/How-Is-Maxillofacial-Jaw-Surgery-Used-To-Treat-Sleep-Apnea.htm
http://doublejawsurgery.com/recovery-timeline



before/after:

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http://mcgannfacialdesign.com/before-after/
http://www.arnettgunson.com/fab-treatment-planning/airway/sleep-apnea-treatment/summary
http://pocketdentistry.com/23-short-face-growth-patterns-maxillomandibular-deficiency/
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Last edited by heilsa on Sat Oct 03, 2015 6:58 pm, edited 2 times in total.



sensorydeprivation wrote:Oh my god, this has never been mentioned here before or on puah.


didnt you know this place is repetitive as fuck? also not everyone posts on that shithole since 2012 my little chinless friend.

feel free to add some pics though



heilsa wrote:Image

Holy shit, from incel to ex college jock. looks at the cheekbones goddammit

I need this
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How much would this cost in UK/US?
"It is not by the principles of humanity that man lives or is able to preserve himself above the animal world, but solely by means of the most brutal struggle."
-Charles Darwin

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I've getting tested for sleep apnea soon and I'm praying I have it because I'd love funded surgery.



This is pretty much the exact surgery I'm getting, except they are going to bring down my maxilla as well.
Life is written in bone.

great pics especially those that include the x-rays

this is a low cut on the maxilla too, imagine having the whole maxilla advanced from right below the eyes, the results would be much better
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Please, stop posting these try-hard photoshopped/tilted pics from Sailer as these are not optimal for reference purposes in my opinion.

Some of the patients (not only the Sailer's one) look unnatural, like they were wearing masks. It may be due to too much advancement at the expense of natural appearance.

This result is cool, but it is total tmj replacement due to condylar resorption/tmj problems.

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improvements yes but it still leaves the negative orbital vector, basically the upper pat of the face that isnt move forward is still recessed, maybe get something done 4 that after for maximum results
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RetractedMaxilla wrote:
puanewb wrote:I see no significant difference, and recall a post like this on puahate despite sensdep saying otherwise.


for me this is significant:
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left: old hog, right: i can sense some femininity and cuteness.
She could have got a liposuction and the result would have been nearly as good.
Warning! The preceding content may contain elements of sarcasm that are difficult to understand for autists. Reader discretion is advised.

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Only for people with overbites though right? If it moves the upper jaw too, why not get a lefort 1?
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gobman3000 wrote:Only for people with overbites though right? If it moves the upper jaw too, why not get a lefort 1?


I don't think you know anything about this

sephon wrote:
I don't think you know anything about this


I honestly don't, enlighten me please?

It looked like most of the patients suffered from a mild-severe overbite in the x-rays, that's why I asked.

Figure 23-2 A 16-year-old girl arrived with her parents for surgical evaluation. She requested a reduction rhinoplasty and a chin implant. A diagnosis of maxillomandibular deficiency with a Class II excess overjet malocclusion was made. She agreed to a surgical and (redo) orthodontic approach. No extractions were carried out, and a degree of incisor proclination was tolerated. The patient’s surgery included maxillary Le Fort I osteotomy (horizontal advancement, vertical lengthening, and clockwise rotation) with interpositional grafting; sagittal split ramus osteotomies (horizontal advancement and clockwise rotation); and osseous genioplasty (vertical lengthening) with interpositional grafting. A, Frontal views in repose before and after treatment. B, Frontal views with smile before and after treatment. C, Oblique facial views before and after treatment. D, Profile views before and after treatment. E, Occlusal views before and after treatment. Only minimal change in the occlusion was required. F, Articulated dental casts that indicate analytic model planning. G, Lateral cephalometric radiographs before and after treatment.
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Figure 23-3 A 24-year-old woman arrived for evaluation. She had previously undergone four bicuspid extractions and orthodontics to neutralize her occlusion during her high school years. Analysis confirmed a short face growth pattern that accounted for the apparent large nose, weak profile, obtuse neck–chin angle, and edentulous look. She agreed to a combined (redo) orthodontic and surgical approach. The patient’s surgery included maxillary Le Fort I osteotomy (horizontal advancement, vertical lengthening, and clockwise rotation) with interpositional grafting; sagittal split ramus osteotomies (horizontal advancement and clockwise rotation); and osseous genioplasty (vertical lengthening and minimal horizontal advancement) with interpositional grafting. Minimal change in the occlusion was required. A, Frontal views in repose before and after treatment. B, Frontal views with smile before and after treatment. C, Oblique facial views before and after treatment. D, Profile views before and after treatment. E, Occlusal views before retreatment, with orthodontics in progress, and after reconstruction. F, Articulated dental casts that indicate analytic model planning. G, Lateral cephalometric radiographs before and after treatment.


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Figure 23-4 A woman in her late 20s arrived for the evaluation of her edentulous look. She had previously undergone orthodontic neutralization of her occlusion during her high school years. Analysis suggested a short face growth pattern that accounted for her apparent large nose, protrusive chin, and edentulous look. The patient also complained of nasal obstruction, restless sleeping, and daytime fatigue. Examination confirmed septal deviation and enlarged inferior turbinates, and an attended polysomnograph documented mild obstructive sleep apnea. She underwent a combined (redo) orthodontic and surgical approach. The patient’s surgery included maxillary Le Fort I osteotomy in segments (horizontal advancement, vertical lengthening, arch expansion and clockwise rotation) with interpositional grafting sagittal split ramus osteotomies (horizontal advancement and clockwise rotation); osseous genioplasty (vertical lengthening and minimal horizontal advancement) with interpositional grafting; and septoplasty and inferior turbinate reduction. A, Frontal views in repose before and after treatment. B, Frontal views with smile before and after treatment. C, Oblique facial views before and after treatment. D, Profile views before and after treatment. E, Occlusal views before retreatment, with orthodontics in progress, and 1 year after reconstruction. Minimal change in the occlusion was required. F, Articulated dental casts that indicate analytic model planning. G, Lateral cephalometric radiographs before and after treatment.


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is it me or is the saggital distance beetween mouth and nose tip (sdlnt) still the same in many post surgery pics?
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Plastic Surgery Case Study: Maxillomandibular Advancement for Sleep Apnea and Improved Facial Profile

Background: Sleep apnea, specifically called OSA or obstructive sleep apnea, can be a limiting condition that adverses affects one’s daytime life. This is evident by excessive daytime drowsiness and problems in concentrating and memory loss. The causes of sleep apnea have been well documented and can involve multiple sites along the nasopharyngeal airway passages for which various types of surgeries can be done.

In severe cases of OSA, the posterior airway can only be improved by moving the base of the tongue and soft palate forward. This is done by moving the jaws forward, known as maxillomandibular advancement. By moving the upper jaw (maxilla) and lower jaw (mandible) forward, the entire airway is enlarged. This procedure serves as the most effective surgical treatment for obstructive sleep apnea. It is usually performed in a hospital under general anesthesia and takes about four hours to complete. Patients usually remain in the hospital for several days after the surgery and can return to work weeks later when much of the facial swelling has gone down.

Unlike traditional orthognathic surgery, the integrity of one’s bite (occlusal relationship) is not changed. As both jaws come forward the same bite relationship is maintained through the use of small titanium plates and screws. As a result of these plates and screws, the jaws do not need to be wired after surgery.

It is recommended that the forward jaw movements be at least 10mms. This creates the maximal change that can be achieved by opening the entire airway space. Its success rate has been documented in numerous studies has being fairly high with a greater than 80% to 90% chance of success for patients with an AHI (apnea hypopnea index) less than 15.

However, moving the jaws forward does have aesthetic consequences. The lower face can become disproportionate to the lower face as the jaw bones come forward leaving the orbital and forehead skeletal structures behind. This can create an undesireable facial protrusive appearance. Proper presurgical selection and patient education with imaging is important to make patients aware of these potential changes.

Case Study: This 26 year-old female suffered from severe obstructive sleep apnea. Sleep studies showed that her ANI was 8 and she did not want to wear a CPAP device. She had significant daytime tiredness with chronic red eyes. She chronically looked very tired.

A 3D CT scan was obtained from which virtual surgical planning was done. It was elected to move the maxilla and mandible forward 7mms and combine that with a sliding genioplasty movement of 9mms forward with a slight vertical opening. Cephalometric, model and photographic analysis was also done to see how these changes would look. Her existing bite was already orthodontically corrected into a Class I relationship.

During surgery, a one-piece maxillary advancement was done of 7mms using an interpositional occlusal splint. (computer made from the stone models) Bilateral sagittal split mandibular osteotomies were then done of 7mms placing it into occlusal relationship with the already advanced maxilla using a final occlusal splint. Finally a sliding genioplasty was performed bringing it forward 10mms with 3mms of vertical opening. Al bone segments were secured by titanium plates and screws and no jaw wiring was used after the surgery.

Her after surgery results (a one month) showed a dramatic positive change in her facial appearance with a better facial profile and facial length. This is not surprising given her significant short mandible, chin and neck. Her sleep apnea had also improved with complete resolution of her daytime sleepiness. The tired red eye look was replaced by a more awake white-eyed appearance.

Undesireable facial changes can occur in some patients after maxillomandibular advancement for sleep apnea. Upper lip protrusion, an open nasolabial angle and bimaxillary protrusion can result from this surgery for certain facial types. Those patients who have a preoperative dolichofacial (long)) or brachyfacial (short) facial types will usually have improved aesthetic outcomes from maxillomandibular advancement for OSA.

Case Highlights:

1) Bimaxillary advancement (upper and lower jaws) can be a very effective treatment for severe obstructive sleep apnea.

2) While moving the jaws forward as much as possible gets the best chance for sleep apnea improvement, it can also cause a facial disproportion and an undesireable change in one’s appearance.

3) Moderating the amount of jaw movement to what aesthetically improves the face as well is an important consideration in treatment planning.

Dr. Barry Eppley

Indianapolis, Indiana






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http://www.exploreplasticsurgery.com/tag/sliding-genioplasty/

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