Complications Associated with Maxillomandibular Advancement

Maxillomandibular advancement is one of the most effective techniques used to treat obstructive sleep apnea. The procedure, however, is not without risk. While serious complications appear to be very rare in orthognathic surgery, there have been various reports of potentially serious, even fatal conditions arising during or after the procedure due to spontaneous pneumomediastinum, pneumothorax, pseudoaneurysm, excessive intraoperative bleeding and delayed secondary hemorrhage, obstructed airway due to swelling, and adverse responses to anesthesia. Complications are rarely fatal. In comparison to these very rare major adverse events, others are slightly more frequent complications, including bad splits, bone necrosis, condylar resorption or malposition, or other temporomandibular joint issues, infections, nerve damage, impaired vision or hearing, or neuropsychiatric challenges, among others. Patient populations at risk for complications and treatment failure include the obese and/or large neck circumference, advanced age, adolescents and young adults, as well as patients with several comorbidities and polypharmacy. Effective communication of the risks of surgery is essential so the patient can make an informed decision led by a surgeon knowledgeable of the wide range of risks and alternatives to provide safe care throughout the treatment continuum.