MMA surgery or TAPIII for symptomatic moderate Obstructive Sleep Apnea (OSA)?

Septo (2009) and multi level throat surgery (2012) brought "severely disordered sleep" w/ AHI 39 to a still symptomatic AHI of 17 (daytime sleepiness, desat, cluster headache). AHI drops to 8 with TAPIII in stage 1/2 and side sleeping. AHI still in 30s supine and in REM. Viewed sleep endoscopy vid with ENT this week, it shows w/ no intervention-palate, etc routinely collapse, completely blocking airway. With jaw thrust forward, airway remains unobstructed. No jaw or bite irregularities.

Doctor Answers 3

Jaw surgery

I have found many patients to be uncomfortable with oral appliances. Also, this device can harm the TMJ.  Maxillomandibular advancement is a more predictable procedure to do in my opinion.  


New York Oral & Maxillofacial Surgeon
5.0 out of 5 stars 14 reviews

Many types of oral appliances to treat snoring/sleep apnea

While TAP3 is fine, there are other options available.  I usually deliver a Narval or Moses appliance, but there are many others that work very well with few side effects.  The key is finding something that is comfortable for you to wear so that you will USE it.  Once delivered, a sleep test is required to verify that the device is working or needs adjustments.

Mild and moderate OSA cases should START with oral appliance therapy, then consider CPAP, and then surgery as a last resort.

MMA or Tap appliance for recalcitrant OSA

There are multiple procedures available for treatment of obstructive sleep apnea. I would start with a consultation with a board certified and fellowship trained sleep surgeon, results of the sleep study, and endoscopy of the upper airway. The evaluation will guide the surgical treatment. MMA and TAP appliances are both viable options. 

Jose E. Barrera, MD, FACS
San Antonio Facial Plastic Surgeon
5.0 out of 5 stars 40 reviews

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