Jaw surgery for sleep apnea: who maxillomandibular advancement is for, how well it works and what recovery is like

Jaw surgery for sleep apnea, called maxillomandibular advancement (MMA), moves both the upper and lower jaws forward so there's more room behind the tongue and soft palate. It's major surgery, but it's also the most effective surgical treatment for obstructive sleep apnea in the published research, with most people seeing large drops in their apnea-hypopnea index (AHI). It's usually considered for adults with moderate to severe sleep apnea who can't use CPAP.

What is jaw surgery for sleep apnea?

Jaw surgery for sleep apnea is an operation that repositions the bones of the face to widen the airway. The National Heart, Lung, and Blood Institute (NHLBI) lists upper and lower jaw advancement among sleep apnea surgeries, describing it as moving the jaws forward to help make the upper airway larger.

University Hospitals in Cleveland describes how it's done. MMA is performed in hospital under general anesthesia. The surgeon moves the upper and lower jaw bones forward through small incisions inside the lips and holds them in place with titanium screws and plates. Before surgery, a CT scan of the face and jaw is used to build a 3D model of the teeth, so the movement can be planned precisely. The hospital says repositioning the bones opens the airway at several points, and the nearby soft tissues shift over time to add more room.

A 2016 meta-analysis in JAMA Otolaryngology put it simply: MMA enlarges the upper airway by physically expanding the facial skeleton. That's the key difference from most other sleep apnea surgery, which trims or tightens soft tissue. Our guide to snoring surgery covers those soft tissue procedures.

Who is MMA for?

MMA is mainly for adults with obstructive sleep apnea who can't tolerate CPAP. University Hospitals lists that as the starting point, with additional criteria that may include:

• Structural problems with the jawbones
• Excess soft tissue in the mouth
• Soft tissue surgery that didn't control the sleep apnea

The American Academy of Sleep Medicine (AASM) published a guideline on surgical referral in 2021. It recommends that clinicians discuss referral to a sleep surgeon with adults who have OSA, a BMI under 40, and are intolerant of or unaccepting of positive airway pressure (PAP), as part of a conversation about alternatives. It also suggests that people with a major upper airway abnormality try PAP first before being referred for upper airway surgery.

Some people do better than others. In a 2010 meta-analysis in Sleep Medicine Reviews, younger age, lower weight before surgery, a lower starting AHI and a larger forward move of the upper jaw all predicted greater success. The 2016 meta-analysis found that a starting AHI below 60 was the factor most strongly linked to cure. People with an AHI above 60 still improved a lot, but were less often cured. If you're not sure what those numbers mean, see what is AHI.

MMA is one of several options. Our overview of sleep apnea treatment options compares it with CPAP, oral appliances and other approaches, and the sleep apnea implant is another surgical route for people who can't use CPAP.

How successful is jaw surgery for sleep apnea?

Jaw surgery for sleep apnea is highly successful in the published studies, which is unusual for sleep surgery. We rate the evidence as moderate because it comes from many case series and pooled patient data rather than randomized trials comparing MMA with other treatments.

Three meta-analyses give a consistent picture:

In the 2016 study, "success" meant an AHI cut by more than half and to below 20, and "cure" meant an AHI under 5. Its patients were often hard cases: 197 of the 268 with available data had already had sleep apnea surgery that hadn't worked. Their daytime sleepiness scores fell from 13.5 to 3.2 on average, and the lowest oxygen level during sleep rose from 70.1% to 87.0%.

The 2025 review called MMA the surgical treatment with the highest success rate for obstructive sleep apnea.

Do the results last?

The longer-term data are smaller but encouraging. A 2015 study in the Journal of Clinical Sleep Medicine followed 30 adults who'd had MMA more than two years earlier. Their average AHI had dropped from 49 to 10.9 events per hour. Just under half (46.7%) had an AHI below 5, and 83.4% had an AHI of 15 or less. Sleepiness, quality of life and diastolic blood pressure improved too, and few long-term side effects were reported.

So MMA doesn't cure everyone. Some people still have mild sleep apnea afterward, and a follow-up sleep study is the only way to know where you stand.

What is recovery like after MMA?

Recovery from MMA takes weeks of careful eating and months of healing. University Hospitals gives this general timeline, noting that it varies from person to person:

• In hospital for one to two days, starting in the recovery unit and then on a ward
• Home with the upper and lower jaws held together by rubber bands, with weekly surgeon visits for four to five weeks while the bands are gradually removed
• A full liquid diet for two weeks, then pureed food, then soft food, then a normal diet
• A gradual return to work or school at weeks three to four, if healing is on track
• Braces at around week six to finish aligning the teeth, a phase that can last several years
• A follow-up sleep study at about three months, once swelling has gone down
• Healing complete at nine to twelve months, when the final result can be judged

The hospital notes that many patients lose 15 pounds or more in the weeks after surgery because of the liquid diet and discomfort when eating. Pain can usually be managed with non-opioid medicines, according to the same page. Your surgical team will give you its own plan, and the length of each stage depends on the surgeon and on you.

What are the risks of jaw surgery for sleep apnea?

The main risk of jaw surgery for sleep apnea is numbness of the lower face, which is common and sometimes lasting. Serious complications are rare in the published series.

The 2025 meta-analysis gives the clearest numbers on side effects:

• Early lower facial numbness in 83.4% of patients
• Lower facial numbness still present in 66.5% at under a year of follow-up, and in 32.7% beyond a year
• Removal of the plates or screws (hardware removal) in 22.0%
• No major complications and no deaths reported

The authors said most side effects were temporary, but that early facial numbness should be clearly explained before surgery so people can make an informed choice.

University Hospitals lists other side effects, including swelling in and around the mouth, numbness of the lips, mouth, cheeks or chin (usually temporary), changes in the bite, and nasal congestion from blood clots after surgery. As with any operation under general anesthesia, there are anesthetic risks, and people with sleep apnea need extra care around surgery. Our guide to snoring after surgery explains why.

Will my face look different?

Moving both jaws forward changes the face slightly. A 2023 meta-analysis in Cureus found that 94.2% of patients were satisfied with their facial appearance after MMA. University Hospitals says its technique moves the jaws forward with a counterclockwise rotation of the upper jaw to help preserve facial characteristics. The hospital also uses a CT scan and a 3D model of the teeth to plan the movement, so it's worth asking your surgeon how your own face is likely to change.

Is MMA better than CPAP?

MMA isn't a replacement for CPAP for most people. NHLBI says a PAP machine is the most common treatment for sleep apnea, and the AASM's guideline frames surgical referral as a discussion for people who can't tolerate or won't accept PAP. If you're struggling with CPAP, there may be fixable problems with the mask or settings first. Our guide to getting used to CPAP covers the common ones.

For people who truly can't use CPAP, MMA has one big practical advantage: once healed, there's no device to put on each night. The authors of the 2015 long-term study suggested MMA should be considered the alternative treatment of choice for people with severe sleep apnea who can't fully stick with CPAP.

When should you see a doctor?

See a doctor if you have signs of sleep apnea, such as loud snoring, breathing that stops and starts, gasping for air, or daytime sleepiness. NHLBI lists these as common symptoms, and you may not know about the nighttime ones until someone tells you. A diagnosis comes first, usually from a sleep study, and then a sleep specialist can talk through treatment.

If you already have sleep apnea and CPAP isn't working for you, ask your sleep doctor whether a referral to a sleep surgeon makes sense. If you're pregnant or planning a pregnancy, raise that with your clinician before any surgical decision. This article is general information, not medical advice.

Read next

• Sleep apnea treatment options
• The sleep apnea implant
• Can sleep apnea go away?

* This content is for informational and educational purposes only and is not medical advice. It is not intended to diagnose, treat, cure or prevent any disease or health condition. Talk to a qualified healthcare provider about your health.