Obstructive sleep apnoea and oral and maxillofacial surgery: when can surgery help?

Obstructive sleep apnoea happens when the airway narrows or closes repeatedly during sleep. These episodes can interrupt breathing and affect the quality of sleep and overall health. Loud snoring, pauses in breathing noticed by a partner, waking with a choking feeling and daytime sleepiness can be warning signs.

The diagnosis cannot be made from snoring alone or from a dental examination. It needs a medical assessment and, usually, a sleep test that confirms the apnoea and measures how severe it is.

How can the jaws affect breathing during sleep?

In some patients, the position or size of the jaws helps narrow the space the air passes through. A lower jaw set further back, or both jaws being underdeveloped, can leave less room for the tongue and for the tissues around the airway.

In selected cases, oral and maxillofacial surgery can change this relationship. One of the procedures used is maxillomandibular advancement: the upper and lower jaws are moved forward, to enlarge the airway and reduce its tendency to close during sleep.

Is surgery suitable for every patient with apnoea?

No. Apnoea has many causes, and surgery is considered only after assessing the anatomy, the sleep test, the patient’s general health and the other treatment options.

For many adults, positive airway pressure therapy (PAP/CPAP) is an effective option. If the patient cannot tolerate it or does not accept it, the doctor can discuss alternatives, including an assessment by a surgeon experienced in treating apnoea. Depending on where the obstruction is, different procedures may be indicated, sometimes carried out together with an ENT doctor and a sleep specialist.

An oral mandibular advancement device is another option for some patients. It is worn during sleep and is not surgery. The device must be made and adjusted individually, and how well it works must be checked through medical follow-up.

What result can surgery give?

Maxillomandibular advancement can significantly reduce the number of apnoea episodes and improve breathing during sleep in carefully selected patients. Even so, improvement does not always mean the apnoea disappears completely. After surgery, a medical reassessment and a repeat sleep test are important, to check the result and decide whether further treatment is needed.

A decision made as a team

The assessment may involve a sleep specialist, an oral and maxillofacial surgeon and, where needed, an ENT doctor and a dentist experienced in oral appliance therapy. The aim is to choose a treatment that fits the patient’s anatomy, diagnosis and needs. Surgery can be an important solution when the structure of the jaws contributes to the obstruction, but the indication and the result are decided case by case.