Maxillomandibular advancement in obstructive sleep apnea syndrome: a surgical model to investigate reverse face lift

Background: The aging process is characterized by multiple signs affecting the upper, the middle, and the lower third of the face; coventionally, face-lift procedures and structural fat grafting are performed to create a younger face. During the life, craniofacial skeleton atrophies, leading to a reduction of the facial height and depth, while increasing the facial width. Maxillomandibular advancement (MMA) by orthognathic surgery restores the lost space dimension, projecting the cheeks, the mouth, and the nose. The aim of this study was to analyze the morphologic change of the face after MMA in patients with obstructive sleep apnea syndrome, focusing on the previously mentioned stigmata of the middle and the lower third of the aging face. Methods: The records of 16 patients who underwent MMA for obstructive sleep apnea syndrome between January 2005 and December 2008 in the Unit of Maxillofacial Surgery at the Novara Major Hospital were included in this study. We explained to the patients the stigmata of a standard aging face, and we asked them to evaluate each sign affecting the middle and the lower third of their preoperative condition. One positive point was given for the presence of each sign reported by the patients. At 2 years after surgery, we asked the patients to evaluate the previously mentioned aging signs of their postoperative face. Again, 1 positive point was given for the presence of each sign reported by the patients. Results: Although we did not perform statistical evaluation, 13 patients showed a degree of rejuvenation after MMA (the score of the postoperative face is less than the score of the preoperative face). Three patients reported no postoperative change; none reported a more aging face, with a successful "reverse face-lift" occurred in 81% of our cases. Conclusions: Simultaneous maxillary and mandibular advancements change the skeletal framework of the face, improving soft-tissue support and resulting in rejuvenation of the middle and the lower third of the face. This condition is demonstrated by the results of our study in that all patients appeared postoperatively more youthful from a self-evaluation.