# Is Maxillomandibular Advancement Possible in Skeletal Class III Patients? A Scoping Review

## TL;DR

This review explores how maxillomandibular advancement can be used in patients with skeletal Class III and sleep apnea, highlighting different techniques and their outcomes.

## Contribution

The study provides a scoping review of MMA techniques tailored for skeletal Class III patients with obstructive sleep apnea.

## Key findings

- Three MMA variations were identified with distinct airway enlargement and aesthetic outcomes.
- All techniques effectively reduced apnea-hypopnea index by at least 50%.
- A decision flowchart was proposed to guide individualized surgical planning.

## Abstract

Unlike skeletal Class I and II patients, the application of maxillomandibular advancement (MMA) in skeletal Class III patients with obstructive sleep apnea (OSA) is not well documented. The aim of this scoping review was to explore the variations and outcomes of MMA techniques in this unique subgroup. A comprehensive search of PubMed, Embase, Cochrane and LILACS databases were conducted for articles published up to May 2025. Nine studies met the inclusion criteria. Three main variations of MMA were identified: (1) Bimaxillary advancement, which provides the most significant airway enlargement across all pharyngeal regions but carries the highest risk of facial aesthetic distortion; (2) Maxillary advancement with mandibular auto-rotation, a less invasive option suited for patients with isolated maxillary retrusion and symmetrical mandibular anatomy; (3) Maxillary advancement with mandibular setback, which addresses aesthetic concerns in patients with mandibular excess but may compromise oropharyngeal airway space. All variations were reported to be effective in treating OSA (Reduction of AHI by at least 50%) but with different considerations. Surgical planning for skeletal Class III patients with OSA should be individualized based on craniofacial morphology, anatomical site of airway obstruction, and aesthetic considerations. A decision flowchart was shared in this study.