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feature article Ian Ormiston The role of maxillo- mandibular advancement surgery in obstructive sleep apnoea Shofiq Aslam pmfa news MR IAN ORMISTON, FDS, RCS, FRCS, FHKAM, CONSULTANT MAXILLOFACIAL CLEFT SURGEON, MAXILLOFACIAL UNIT, LEICESTER ROYAL INFIRMARY, LEICESTER, UK. SHOFIQ ISLAM, MBBCH (HONS), BDS, DOHNS, MFDS, MRCS, SPECIALTY REGISTRAR IN ORAL AND MAXILLOFACIAL SURGERY, MAXILLOFACIAL UNIT, LEICESTER ROYAL INFIRMARY, LEICESTER, UK. F acial surgery for the correction of acquired or developmental skeletal and occlusal abnormalities has been practised within the scope of oral and maxillofacial surgery (OMFS) for several decades. OMFS surgeons have an understanding of the influence of skeletal movements on the soft tissues of the head and neck and the corresponding alterations in facial appearance with the required movements. There has been an increased appreciation over recent years of the affect these movements also have on the posterior airway space at both the level of the tongue base and at the level of the palate. This has led to the application of maxillomandibular advancement (MMA) surgery as a highly successful multilevel treatment of severe obstructive sleep apnoea (OSA). Background Continuous positive airway pressure (CPAP) remains the gold standard treatment for OSA [1,2]. The Cochrane Review originally carried out in 2005 concluded that the available evidence did not support the widespread use of surgery in people with mild to moderate daytime symptoms associated with sleep apnoea [3]. Unfortunately, however, in the patients we see with moderate to severe OSA a high proportion are unable to tolerate CPAP for a number of reasons. This is in keeping with the literature, which demonstrates rates of non adherence can range from 29-83% when adherence is defined as at least four hours of use per night [4]. Given that CPAP will be a lifelong commitment for most, it becomes apparent why there is an ever increasing demand for effective surgical options. We believe there is a role in selected cases for a successful single surgical procedure, which improves the airway at multilevels. Introduction to skeletal surgery Oral and maxillofacial surgeons with an interest in orthognathic surgery have experience of performing mandibular and maxillary osteotomies in the management of acquired or developmental abnormalities of the facial skeleton and occlusion. This type of surgery leads to an altered facial appearance and improved functional occlusion, which is often the patient’s reason for seeking the treatment. Addressing Figure 1: Lateral cephalometric radiographs showing the posterior airway space before (left) and after MMA (right). 16 l volume 1 issue 6 volume 1 issue 6 I 17