Orthognathic Surgery
Repositioning the jaws to open the airway and balance the bite.
What it is
Orthognathic surgery is the surgical repositioning of the upper jaw (maxilla), the lower jaw (mandible), or both. The most powerful version for airway purposes is called maxillomandibular advancement (MMA), in which both jaws are moved forward by 8 to 12 millimeters. This pulls the soft palate, tongue base, and surrounding airway tissues forward with them, dramatically enlarging the airway from the nose all the way down to the throat.
Why we do it
When the upper or lower jaw is too small or set too far back, the airway behind it is narrow. No CPAP, oral appliance, or weight loss can change that underlying skeletal anatomy. MMA has the highest documented success rate of any surgical treatment for severe obstructive sleep apnea, with cure rates above 85 percent in well-selected patients (compared to 30 to 50 percent for soft-tissue surgery alone). It is also the definitive treatment for skeletal open bite, severe overbite or underbite, and facial asymmetry.
What happens during the procedure
Performed in a hospital under general anesthesia, with all incisions inside the mouth (no visible scarring). The surgeon makes precise cuts in the jaw bones (Le Fort I osteotomy for the upper jaw, bilateral sagittal split osteotomy for the lower jaw), repositions the bones to a planned new location based on 3D virtual surgical planning done weeks in advance, and secures them with small titanium plates and screws. Modern technique does not require the jaws to be wired shut.
Who it’s for
Adults (after facial growth is complete) with moderate to severe sleep apnea who have failed or cannot tolerate CPAP, who have a clear skeletal cause on imaging, or who want a single definitive intervention. Also patients with significant bite or jaw imbalance affecting function and appearance. Coordinated with orthodontics for 12 to 18 months before surgery to position the teeth for the planned skeletal move.
Recovery and what to expect
Two nights in the hospital. Soft diet for six weeks. Most patients return to office work at three to four weeks, full activity at eight weeks. Some lower-lip and chin numbness is expected and resolves over six to twelve months as the inferior alveolar nerve recovers. Most patients describe the breathing change as life-changing within the first weeks, with many noticing they sleep through the night for the first time in years.