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Impact of surgical maxillomandibular advancement upon pharyngeal airway volume and the apnoea–hypopnoea index in the treatment of obstructive sleep apnoea: systematic review and meta-analysis
  1. Maria Giralt-Hernando1,
  2. Adaia Valls-Ontañón1,2,
  3. Raquel Guijarro-Martínez1,2,
  4. Jorge Masià-Gridilla1,2 and
  5. Federico Hernández-Alfaro1,2
  1. 1 Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya Facultat de Medicina i Ciencies de la Salut, Sant Cugat del Valles, Spain
  2. 2 Department of Oral and Maxillofacial Surgery, Centro Medico Teknon, Barcelona, Spain
  1. Correspondence to Dr Maria Giralt-Hernando; mariagiralth{at}


Background A systematic review was carried out on the effect of surgical maxillomandibular advancement (MMA) on pharyngeal airway (PA) dimensions and the apnoea–hypopnoea index (AHI) in the treatment of obstructive sleep apnoea (OSA), with the aim of determining whether increased PA in the context of MMA is the main factor conditioning the subsequent decrease in AHI.

Methods A search was made of the PubMed, Embase, Google Scholar and Cochrane databases. A total of 496 studies were identified. The inclusion criteria were a diagnosis of moderate to severe OSA, MMA success evaluated by polysomnography, reporting of the magnitude of MMA achieved, PA increase and a minimum follow-up of 6 months.

Results Following application of the eligibility criteria, eight articles were included. Metaregression analysis showed MMA to significantly increase both pharyngeal airway volume (PAV) (mean 7.35 cm3 (range 5.35–9.34)) and pharyngeal airway space (mean 4.75 mm (range 3.15–6.35)) and ensure a final AHI score below the threshold of 20 (mean 12.9 events/hour).

Conclusions Although subgroup analysis showed MMA to be effective in treating OSA, more randomised trials are needed to individualise the required magnitude and direction of surgical movements in each patient, and to standardise the measurements of linear and nonlinear PAV parameters.

  • orthognathic surgery
  • obstructive sleep pnea syndrome
  • obstructive sleep apnea
  • upper airway
  • oximetry

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  • MG-H and AV-O contributed equally.

  • Contributors All of the authors have seen and approved the manuscript and have given license for publication. All of the authors have contributed to planning, conduct and reporting of the work described in the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer All of the authors have seen and approved this manuscript and give license for publication.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository.

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