Double jaw surgery (maxillomandibular osteotomies and advancement) with counter-clockwise rotation is very effective in producing a stable significant increase in the posterior airway space (PAS) resulting in an improvement in obstructive sleep apnea.

Obstructive Sleep Apnea is a condition where significant airway obstruction problems develop during sleep. The most common cause of airway obstruction involves nasal airway obstruction and/or a decrease in the oropharyngeal airway space (space between the back of the tongue and the back of the throat). The following research conducted by Dr. Wolford discusses the change in the posterior airway space (PAS) relative to the amount of maxillomandibular advancement (double jaw surgery) with counter-clockwise rotation.

Posterior Airway Space Changes after Double Jaw Surgery with Counter-Clockwise Rotation

By Larry M. Wolford, DMD, Oscar Reiche-Fischel, DDS, Marcos C. Pitta,DDS,Mark J. Kortebein, DDS, Pedro F. Franco, DDS

Retrusion of the maxillomandibular complex with a high occlusal plane angle (OPA) is often seen in obstructive sleep apnea syndrome (OSAS), because of an associated decrease in the posterior airway space (PAS). This study evaluates the change in the PAS relative to the amount of maxillo-mandibular advancement with counter-clockwise rotation.

Seventy-two patients, 58 females and 14 males, age range 12-56 yrs., underwent maxillary and mandibular advancement with counter-clockwise rotation. Postoperative follow-up averaged 3 yrs. (R 1 to 8.1 yrs.). Immediate pre-op (T1), immediate post-op (T2), and long-term follow-up (T3) lateral cephalograms were analyzed for surgical change (T2 – T1), long-term stability (T3 – T2), and long-term change (T3 – T1). PAS was measured at its narrowest dimension from posterior pharyngeal wall to the base of the tongue.

The patients were divided in groups according to the amount of preoperative PAS: Group 1a, 0 to 6mm PAS (21 pts.), and Group 1b, >6mm PAS (51 pts.); and according to the amount of mandibular advancement (MA): Group 2a, 0 to 10mm (31 pts.), Group 2b >10 to 15mm (25 pts.), and Group 2c >15mm (16 pts.). The dimensional change in the PAS was then correlated with the amount of the mandibular advancement (measured at the genial tubercles) and change in OPA. All measurements were made parallel or perpendicular to Frankfort Horizontal (FH), depending upon the movement (vertical-or horizontal).


 No. ofMMOPA ∆PAS ∆% ∆ PAS
 Pts.(mm)(Degrees)(mm)to MA
Group 1a2114.1 (R 5 to 29)11.1 (R 2 to 25)7.0 (R 3 to 14)49.6
Group 1b5111.0 (R 3 to 28)8.6 (R 2 to 21)6.1 (R 2 to 18)55
Group 2a317.4 (R 3 to 10)6.9 (R 2 to 12)4.9 (R 0 to 9)66
Group 2b2512.5 (R 11 to 14)9.8 (R 1 to 16)7.0 (R 2 to 11)56
Group 2c1620.0 (R 16 to 29)12.5 (R 4 to 20)8.3 (R 3 to 18)41

In this study, the PAS increased with counter-clockwise advancement of the maxillary/mandibular complex, showing an increase range from 41% to 66 % in relation with the amount of mandibular advancement measured at the genial tubercles. Group 2a, with a 0 to 10 mm range of advancement, showed the highest PAS change (66%).

Maxillary and mandibular osteotomies with counter-clockwise rotation is very effective in producing a stable significant increase in the PAS.


  • Riley RW, Powell NB, Guilleminault C: Obstructive Sleep Apnea Syndrome: A Surgical Protocol for Dynamic Upper Airway Reconstruction. J Oral Maxillofac Surg 51: 742, 1993
  • Wolford LM, Chemello PD, Hilliard FW: Occlusal Plane Alteration in Orthognathic Surgery. J Oral Maxillofac Surg 51:730, 1993