Bony Surgery for Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a multifactorial condition characterized by upper airway collapse, in which craniofacial skeletal morphology plays a critical role in both pathogenesis and management. Among surgical treatment options, maxillomandibular advancement (MMA) is widely regarded as the most effective skeletal procedure for moderate to severe OSA, as it enlarges the upper airway by advancing the maxilla and mandible and stabilizing the surrounding soft tissues. This chapter outlines the principles, surgical techniques, and clinical considerations of bony surgical interventions for OSA, including Le Fort I osteotomy, bilateral sagittal split osteotomy (BSSO), and adjunctive genioplasty. Key steps in surgical planning, intraoperative technique, and postoperative assessment are discussed. Imaging modalities, including lateral cephalometry and advanced three-dimensional techniques such as cone-beam computed tomography (CBCT), computed tomography (CT), and magnetic resonance imaging (MRI), are also reviewed as essential tools for evaluating craniofacial structure, guiding surgical planning, and assessing treatment outcomes. Together, these approaches support a comprehensive, anatomically driven strategy for the management of OSA.