Jaw surgery, orthodontics and sleep apnea

Obstructive sleep apnea is a medical diagnosis, made from a sleep study and managed by a physician. Nothing on this page changes that. What an orthodontist contributes is a view of the skeleton around the airway, because the upper and lower jaws form the walls and floor of the space the tongue and soft tissues occupy, and where those jaws sit determines how much room there is.

For a subset of patients, jaw position is not a contributing detail. It is the main obstruction. Those are the patients for whom surgery is discussed.

Maxillomandibular advancement

MMA moves both jaws forward together, a Le Fort I on the upper jaw and a BSSO on the lower, in one operation. Advancing the jaws carries the tongue and the soft palate forward with them, because those structures are attached to the bone. The airway behind them enlarges.

It is the most effective surgical option for obstructive sleep apnea in appropriately selected adults, and it is the reason the same operations described elsewhere on this site appear in a sleep medicine context. The selection is the hard part: it is offered to patients with moderate to severe OSA, generally after CPAP has been tried and could not be tolerated, and where assessment shows the obstruction is at a level that jaw advancement will actually address.

It changes facial appearance. For many patients with a recessive lower jaw the change is welcome, but it should be discussed openly beforehand rather than discovered afterwards.

Where the non-surgical options sit

Most people with sleep apnea never need jaw surgery. The ladder generally runs:

• CPAP. The reference treatment. Effective when worn.
• Oral appliance therapy. A custom device worn at night that holds the lower jaw slightly forward. Suits mild to moderate OSA and patients who cannot tolerate CPAP. Made and fitted by a dentist or orthodontist, on physician referral, with follow-up testing. See sleep and breathing.
• Weight, position, nasal treatment, ENT surgery where relevant, often addressed alongside the above.
• Expansion. In adults, MARPE or SARPE where a narrow upper jaw is part of the picture. Adjunctive rather than curative.
• MMA. For selected patients when the above have failed or are not appropriate.

Children are a different conversation entirely

Paediatric sleep-disordered breathing is not adult apnea in a smaller person. The most common cause is enlarged tonsils and adenoids, and the first step is an ENT assessment, not orthodontics. Jaw surgery has essentially no place in an otherwise healthy growing child.

What does have a place is growth. A child's upper jaw can be widened with a simple expander while the palate is still a flexible seam, and a retruded lower jaw can be influenced with functional appliances during a growth spurt. Both have published evidence behind them in children with sleep-disordered breathing: a meta-analysis of expansion in children with a narrow palate and sleep apnea found apnea events fell by about 70 percent, and long-term follow-up shows the result holding into adulthood. They change the shape of the structures around the airway at the only time in life when that can be done without screws or scalpels, and they work best alongside the child's physician and ENT. The studies are listed on the airway orthodontics page.

This is the practical case for looking early. Signs worth mentioning to us or to your physician include snoring most nights, mouth breathing, restless sleep, waking unrefreshed, bedwetting past the usual age, and daytime behaviour or attention difficulties. See snoring in kids, mouth breathing, and airway orthodontics.

What we will and will not tell you

We will look at your jaws, your airway space, your tonsils, your tongue posture and your bite, and tell you what we see. If the picture suggests sleep-disordered breathing, we will say so and ask you to see your physician, because a diagnosis requires a sleep study and we cannot make one.

We will not overstate what any single treatment can do for diagnosed sleep apnea, and we will not tell you the jaws are irrelevant to it, because the research says they are not. Between those two points is an honest account of what jaw width and position do to an airway, and that is what an assessment is for.

What it costs in British Columbia

The surgery itself, surgeon and hospital, is generally covered by MSP when it is medically required and performed in hospital. Your oral and maxillofacial surgeon's office confirms that for your case. The orthodontic treatment before and after surgery is not covered by MSP; we quote that at your evaluation and offer an interest-free monthly plan through the clinic. Full detail on the orthognathic surgery page and in cost and insurance.