MMA Surgery Helped My Sleep Apnea but Left Me with a Longterm Permanent Injury

Kathy Prince, a hospital clinical pharmacist by training and a patient advocate, underwent maxillomandibular advancement (MMA) surgery, after struggling to adapt to CPAP therapy. But the procedure left her with numbness that has affected her speech and eating—and converted her into a patient safety advocate.

Obstructive sleep apnea (OSA) seems to be an epidemic, especially among my generation. 

I fit the typical profile of a person born in the ’50s or ’60s: bottle-fed as an infant, underwent premolar extractions to fit in crowding teeth, and had subsequent orthodontics to make all those teeth fit into jaws that were just not adequately developed to hold them all. As an adult, I developed sleep-disordered breathing due to having such a small airway, though it was many decades before I was diagnosed with a proper sleep study. I was fatigued on a daily basis, and I was a woman with those complaints—doctors all told me it must be my hormones or the onset of hypothyroidism. It was none of that. It was obstructive sleep apnea. I was 64 before I was diagnosed.

Sleep causes us to lose the muscle tone we normally have in daytime hours. For OSA patients, our narrowed airway spaces collapse, and we repeatedly struggle for adequate breath and oxygen. Our body sends out adrenaline and cortisol to stimulate our brain to repeatedly wake and momentarily regain oxygen to our vital organs. It becomes a vicious metabolic cycle that robs us not just of healthy sleep but also healthy metabolism, and that leads to chronic illnesses. Positive airways pressure (PAP) therapy is the best option that medicine has to offer to combat this. Or so we are told.

I went on PAP therapy in the fall of 2023. It was a traumatic thing to adjust to. It is not natural to sleep attached to a hose of pressurized air. While some people immediately are grateful for the breathing relief continuous positive airway pressure (CPAP) can give, others find it a struggle to adapt. I was one of those people. 

After months of trying to adjust, I found that while I could get to sleep with the mask, after a few hours I woke up again—and going back to sleep was difficult. I was aware of the pressurized air, and that feeling was anxiety-producing. I never got past it. I was getting less and less sleep, and I was feeling worse and worse and more and more anxious. 

MMA: A Surgical Solution for OSA?

I had to try to find an alternative and looked into literally every option that was available. I saw a dentist specializing in oral appliances and an ear, nose, and throat (ENT) doctor offering soft tissue surgeries and hypoglossal nerve stimulator therapy. Ultimately, I was referred to an oral surgeon offering the definitive surgical option: a form of jaw surgery known as maxillomandibular advancement, or MMA.

MMA surgery rebuilds the actual airway itself by moving the bones that house the soft tissues of the pharynx. Once the bones are repositioned, the airway is significantly and permanently expanded, making it a highly effective treatment for OSA. 

MMA Risks You Should Be Aware Of

As I learned, unfortunately, although MMA offers much hope to resolve OSA permanently, it is one of the most invasive surgical options and has a long and difficult recovery period. It also carries significant risks. The most significant of these include neurosensory deficits such as numbness (also called hypoesthesia) in the lower lip and chin. This has been reported to affect 25-85% of patients. It often resolves within 12 months, but it is persistent in some cases—a permanent sensory loss. 

I also learned that oral surgeons who offer MMA are rare and are usually located in major medical centers. 

My MMA took place on August 7, 2024. … I remember very clearly a day in the spring of 2024, sitting in my consultation appointment and asking questions about postoperative numbness. I was reassured it was rare. I was reassured it was always minor. I was told it might be a tiny spot of numbness in the chin that a patient hardly even notices and not to worry about such an insignificant thing as that. 

Seven months after my surgery, on my final post-surgery clinic appointment with my oral surgeon on March 25, 2025, my surgeon finally disclosed the potential for Serious nerve damage —because it had happened to me. 

After that day, I learned much more about the surgical procedure in MMA known as bilateral sagittal split osteotomy (BSSO), which involves cuts on the lower jaw and poses a significant risk of damage to the nerve that provides sensation to the lower lip, chin, teeth, and gums. I learned that there are a number of ways that nerve, the inferior alveolar nerve (IAN), can be damaged during surgery. And I learned about a number of factors that can contribute to that damage, including 

• patient age above 30 years

• female sex (due to bone density)

• the anatomy of the mandible

• surgeon experience

• imprecise surgical technique in cutting bone

• use of bicortical screws, which, when overtightened, can lead to compressed nerves

In my case, a screw crushed and compressed my nerve, damaging it—causing numbness and pain. I quickly took my concerns to the medical center’s patient advocate and was referred for diagnostic imaging. I underwent a microscopic nerve repair in Dallas, Texas, in late June. 

How Can This Procedure Be Made Safer?

There are technologies and procedures available that hospitals can use to help avoid nerve damage like mine. Intraoperative nerve navigation can help surgeons visualize, monitor, and navigate nerves during surgery. Offering magnetic resonance neurography early after surgery can help identify swelling or trauma-related nerve injuries—and help patients get timely treatment.

Since my surgery, I have been advocating—and calling on other patients and medical professionals to advocate—for hospitals to adopt these strategies. Patients considering MMA should talk to their doctors. I want future patients considering MMA to receive honest information, meaningful informed consent, early diagnosis of complications, and access to tools that make this surgery as safe as possible. and companies should engage with patient organizations such as the Alliance of Sleep Apnea Patients to understand what outcomes matters to patients.