Maxillomandibular Advancement for Sleep Apnea in Austin, TX Maxillomandibular advancement (MMA) for sleep apnea in Austin, TX is a surgical treatment for obstructive sleep apnea that opens the upper airway by moving both the upper and lower jaws forward together. At Oral Surgery Specialists of Austin in South Austin, we perform MMA for patients who already have a confirmed sleep apnea diagnosis from a sleep physician, and who have tried CPAP, an oral appliance, or both without lasting success. We do not diagnose sleep apnea; we coordinate with your sleep physician to provide a surgical option when non-surgical paths have not worked.For many patients with obstructive sleep apnea, the underlying cause is anatomic: the airway behind the tongue collapses during sleep because the bones that support it (the upper jaw and the lower jaw) sit too far back. CPAP works by pumping pressurized air to keep the airway open. An oral appliance works by holding the lower jaw forward through the night. MMA addresses the anatomy directly, advancing the jaws (and the soft-tissue structures attached to them) by approximately ten millimeters, which enlarges the airway permanently. Our role is the surgical option for sleep apnea, performed in coordination with the sleep physician who diagnosed you. The broader sleep apnea treatment discussion at our office covers how MMA fits alongside CPAP, oral appliances, and other approaches. MMA is a major surgery, and we are direct with you about that. The decision to proceed is something we work through with you and your sleep physician based on your sleep study, your CPAP and appliance history, your anatomy, and your goals. On This PageWhat Is Maxillomandibular Advancement Surgery? Maxillomandibular advancement is a two-jaw orthognathic surgery, the same family of surgery used to correct skeletal jaw misalignment, applied specifically to enlarge the upper airway. We make precise cuts in the upper jaw (maxilla) and lower jaw (mandible), advance both bones forward together by approximately ten millimeters, and secure them in the new position with titanium plates and screws. The soft-tissue structures attached to the jaw bones (the tongue, soft palate, and surrounding throat tissues) move forward with the bones, which is what enlarges the airway.Other surgical options for sleep apnea exist, including soft-palate surgery, tongue-base surgery, and hypoglossal nerve stimulators. MMA targets the bony structure of the airway rather than soft tissue alone. For patients with a clear anatomic cause and a documented failure of non-surgical treatment, MMA tends to produce the most reliable improvement in apnea-hypopnea index (AHI) of any surgical approach. Your sleep physician and our surgical team look at your specific anatomy on a CBCT scan to determine which surgical option, if any, makes sense for you. MMA is appropriate for patients with confirmed moderate-to-severe obstructive sleep apnea whose anatomy shows clear airway obstruction at the level of the soft palate, tongue base, or both. We expect you to have already tried CPAP and oral appliance therapy. We do not perform MMA on patients whose sleep apnea has not been confirmed by a sleep study, and we do not perform it as a first-line treatment. When MMA Is Not the Right StepMMA is not the right step for everyone with sleep apnea. Patients whose CPAP works well and is tolerated should generally stay on CPAP. Patients whose airway obstruction is purely soft-tissue (a long uvula, large tonsils) may benefit more from a less invasive surgical option. Patients with significant medical comorbidities that make a multi-hour surgery higher-risk than usual may not be candidates. We tell you honestly when MMA is not indicated, even if you came in hoping it would be. Your MMA Surgeons in AustinMMA is a complex two-jaw orthognathic surgery, and the surgeon performing it should have strong residency training in jaw surgery and a clear understanding of how to coordinate with the sleep medicine specialist who diagnosed you. Both Oral Surgery Specialists of Austin surgeons are board-certified oral and maxillofacial surgeons with full residency training in orthognathic technique. Dr. Derrick Flint completed his oral and maxillofacial surgery and anesthesia residency at the University of California, San Francisco, followed by a fellowship in cosmetic and cleft lip and palate surgery. He is a Diplomate of the American Board of Oral and Maxillofacial Surgery and was the recipient of the AAOMS Dental Implant Student Award. His residency at UCSF included orthognathic surgery training, the same surgical foundation MMA is built on. More on Dr. Flint’s bio. Dr. Ricardo Garza earned his DMD from Harvard School of Dental Medicine and his MD in 2020, then completed his oral and maxillofacial surgery residency at UT Health San Antonio. He has done mission work in Neiva, Colombia centered on cleft and orthognathic surgery, and he is fluent in both English and Spanish. That fluency matters here because MMA decisions involve multi-hour clinical conversations about a major surgery, and a patient should be able to follow that conversation in their primary language. Background on Dr. Garza’s bio. The MMA Process from Sleep Study to Post-Op RecoveryMMA is the longest-pathway surgery we perform: from confirmed diagnosis to post-op sleep study, the full timeline often runs eighteen months or more. Below is what each stage looks like and which provider on your care team handles it. Stage 1: Confirmed Diagnosis and Trial of Non-Surgical TreatmentBefore we ever see you, your sleep physician should have confirmed obstructive sleep apnea with a sleep study and you should have tried CPAP, an oral appliance, or both. If you have not yet seen a sleep physician or had a sleep study, that is the first step. We can refer you to sleep medicine specialists in the Austin area but cannot replace that step ourselves. Stage 2: Surgical Consultation and 3D ImagingAt our office, we take a cone beam CT scan and review the airway anatomy across the full upper airway. We map where the obstruction sits and how the jaws relate to it, and we estimate the airway change MMA would produce. We also coordinate with your sleep physician to review your sleep study, AHI, oxygen desaturation pattern, and CPAP and appliance history before recommending surgery. Stage 3: Pre-Surgical Orthodontics (When Needed)Most MMA patients do a period of pre-surgical orthodontic alignment to position the teeth where they need to sit after the jaws move. An orthodontist on your care team handles this stage, and it typically takes between six and eighteen months depending on starting alignment. Some patients (particularly those whose teeth already align well) skip this stage. We coordinate the surgical plan with the orthodontist throughout this period. Stage 4: The SurgeryMMA is a hospital-based procedure under general anesthesia managed by a hospital anesthesia team. Our surgeons perform the procedure at Seton, St. David’s, or Dell/Seton University Medical Center. The surgery itself takes approximately three to five hours. We make precise cuts in both jaws, advance them forward together according to the pre-surgical plan, and secure them with titanium plates and screws. Patients typically stay in the hospital for one to two nights for monitoring, IV fluids, and pain management. Stage 5: Recovery and HealingSoft-tissue swelling is significant in the first week and resolves over four to six weeks. Most patients are on a soft or liquid diet for six weeks while bone heals around the plates and screws. Bone integration takes three to six months, after which most patients are fully healed and back to normal function. Most patients return to desk work after two to three weeks; physically demanding work may need a longer recovery window. Stage 6: Post-Op Sleep StudyAt three to six months post-op, your sleep physician will typically order a follow-up sleep study to measure the change in your AHI and confirm that the surgery produced the expected airway improvement. This visit is back with your sleep physician, not with us, but we coordinate on the result so that any post-op care decisions can factor it in. Outcomes of MMA SurgeryThe primary measurable outcome of MMA is a reduction in apnea-hypopnea index. Published outcomes for MMA in appropriately selected patients show AHI reductions of around 80 percent, with many patients reaching AHI levels below the threshold for clinical resolution of obstructive sleep apnea. The CBCT planning we do in our office before surgery is what allows us to estimate, case by case, what airway change to expect. Beyond AHI, patients typically report meaningful improvements in daytime energy, cognitive function, and the ability to drive and work without exhaustion. Most patients also report substantial reduction or elimination of snoring. These quality-of-life outcomes are what most patients name as the reason they pursued surgery in the first place, and they are what we ask about at the post-op visits we schedule throughout the first year. For many MMA patients, the surgery means they no longer need CPAP. This is the outcome patients are most often hoping for, and we want to be honest with you: it is achievable for many MMA candidates but not guaranteed for all. Some patients with severe baseline AHI still need CPAP at lower pressures after surgery; some are fully off it. We discuss your specific likely outcome based on your scan and your sleep study before scheduling surgery. MMA is a one-time surgery, but sleep apnea care continues for life. Your sleep physician remains the lead provider for monitoring AHI over time, adjusting any residual treatment, and managing other sleep disorders. Our role ends when the surgical site has healed and the post-op sleep study confirms what the airway is doing. After that, you are back in your sleep physician’s care. Continuity matters across this long pathway. Because Dr. Flint and Dr. Garza both have orthognathic training, your surgical pathway stays in one practice from the planning visit through the post-op follow-up. Your CBCT, surgical plan, and operative records all stay together in one office, and you are seeing the same surgical team you met at the consultation throughout the entire recovery period. Why Choose Our Team for MMAMMA is one of the most complex elective surgeries an oral and maxillofacial surgeon performs. It requires precise pre-surgical planning, hospital-based surgical infrastructure, and post-op monitoring across the next several months. The surgeons performing it should have full residency training in orthognathic surgery and direct working relationships with sleep medicine specialists. At Oral Surgery Specialists of Austin, we treat MMA exactly that way: every case planned from CBCT, every surgery scheduled at one of our hospital affiliations, every patient followed through the post-op sleep study with their sleep physician. We plan every MMA case from a CBCT scan we take in our office, not from outside imaging. The scan defines exactly how far each jaw can advance, what the airway change will look like, and where the structural limits are (the maxillary sinus, the inferior alveolar nerve, the position of the existing teeth). We review the plan with you in the same visit. MMA happens at the hospital, not in our office. Both surgeons perform surgery at Seton, St. David’s, and Dell/Seton University Medical Center, where the anesthesia team, operating room equipment, and post-op nursing are designed for multi-hour orthognathic procedures. We do not diagnose sleep apnea, and we do not replace your sleep physician. Our role is the surgical option, performed in coordination with the physician who has been managing your apnea. We share your CBCT, surgical plan, and operative notes with them, and we ask the same of them around your sleep study, CPAP record, and post-op follow-up. We tell you honestly when MMA is not indicated for your specific anatomy or apnea pattern, even if you came in hoping for surgery. The procedure is too invasive, the recovery is too long, and the cost is too significant to recommend it for patients who are not the right candidate. You deserve a surgeon who is willing to say no when no is the right answer. MMA Cost and InsuranceMMA for documented moderate-to-severe obstructive sleep apnea is a medically necessary procedure, and most medical insurance plans cover it when the documentation supports the medical necessity (sleep study results, CPAP failure or intolerance, anatomic appropriateness). The coverage process typically requires pre-authorization based on your sleep physician’s records and our surgical plan. We handle the documentation submission for you. Cost depends on your specific insurance plan, including deductible, out-of-pocket maximum, and any coverage limitations on the surgical site of service. We do not provide a flat price for MMA because the actual cost depends so heavily on your insurance coverage. We provide a written estimate after the consultation and pre-authorization, including hospital and anesthesia fees. For the portion not covered by insurance, oral surgery financing through outside lenders is available, including dedicated medical loans. We will be straight with you about what insurance covers and what it does not before we schedule any surgery. Schedule an MMA ConsultationIf you have a confirmed sleep apnea diagnosis and you are considering MMA, we would like to review your case. Call us at (512) 547-6852 or request an appointment online. We are at 5301 Davis Ln, Suite 102 in South Austin, TX 78749. You can also reach us through our Contact page with any questions before booking. Frequently Asked QuestionsHow is MMA different from CPAP or an oral appliance?MMA is the surgical step in the sleep apnea treatment hierarchy, used when first-line treatments have not produced lasting results. CPAP and oral appliances work well for most patients with obstructive sleep apnea, and they should be tried first because they are non-invasive and reversible. We reserve MMA for patients for whom those treatments have not worked, who have a documented diagnosis, and whose anatomy supports a surgical airway change. Is MMA a major surgery?Yes. MMA is among the more invasive jaw surgery procedures an oral and maxillofacial surgeon performs. Less invasive surgical options for sleep apnea exist, including soft-palate surgery and hypoglossal nerve stimulators, and your sleep physician and our surgical team will discuss those alternatives with you if MMA is not the right fit. We are direct with patients about the scope of recovery before scheduling, and we do not push MMA on anyone who has a less invasive option that suits their anatomy. Will MMA cure my sleep apnea?For most appropriately selected patients, MMA produces significant improvement in apnea-hypopnea index, often reducing it below the diagnostic threshold for sleep apnea. Whether your specific case will reach “cure” levels depends on your starting AHI, your specific anatomy, and how much airway change the surgery achieves. We give you an honest estimate based on your CBCT scan and sleep study during the consultation, not a guarantee. Will my face look different after MMA?Yes. MMA moves both jaws forward by approximately ten millimeters, which produces a visible change in the chin, lower face, and profile. Most patients describe the change as subtle and natural-looking. Some patients consider the facial change a positive (the lower face appears more balanced); others find it an adjustment. The same orthognathic technique appears in our surgical correction of jaw asymmetry for patients with skeletal misalignment, where the surgical mechanism is similar but the goal is different. We show you the expected facial change on the CBCT-based plan during consultation so you know what to expect before deciding. How long until I can return to work after MMA?Plan for two to three weeks before returning to desk work, and four to six weeks before physically demanding work that involves heavy lifting, contact sports, or significant jaw use. Bone integration takes three to six months, but you do not need to be off work for that entire period. Most of that time you are gradually returning to normal activity, avoiding hard food and contact sports. The first two weeks call for significant rest, with activity gradually increasing through the second and third week. Will I need braces before or after MMA?Most likely yes. The standard MMA pathway includes a period of pre-surgical orthodontics with an orthodontist (six to eighteen months) before the jaws advance, and some patients also need a shorter period of post-surgical orthodontics afterward to fine-tune the bite. The orthodontic stages happen with an orthodontist on your care team, not with us; we plan the surgery so that it fits cleanly into the orthodontist’s broader plan. Does insurance cover MMA?Most medical insurance plans cover MMA itself when documentation supports medical necessity (a confirmed sleep apnea diagnosis, documented CPAP or oral appliance failure, and anatomic appropriateness). What insurance typically does not cover is the pre-surgical orthodontics, which is billed separately by the orthodontist’s office and is treated as orthodontic care, not surgical care. We handle the surgical pre-authorization and tell you in writing what your specific plan covers before you schedule. More on financing options for any out-of-pocket portion. What happens if MMA does not fully resolve my sleep apnea?If a post-op sleep study shows residual sleep apnea (which can happen even after a successful surgery, particularly for patients with very high baseline AHI), the next step is back with your sleep physician for further treatment. Some patients still benefit from CPAP at lower pressures after surgery, and others need supplemental therapy targeting different parts of the airway. We discuss the realistic possibility of residual apnea before surgery so you can factor it into your decision. |
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