Sleep Apnea Treatment – Mandibular Advancement Appliance


More than 20 million Americans suffer from obstructive sleep apnea. The breathing condition often goes undetected or undiagnosed and negatively affects sleep quality.

What is Obstructive Sleep Apnea?

“Apnea” means “without breath,” and apnea events are episodes of interrupted breathing. Obstructive sleep apnea affects an individual’s ability to breathe during sleep because of a physical obstruction, typically in the roof of the mouth, tongue, throat or nose.

Mandibular Advancement Appliance. These devices are worn at night to help open up the airway and prevent apnea events. A mandibular advancement appliance is built with an interconnected upper and lower tooth guard. Using the upper teeth as the focal point, the device moves the lower teeth and jaw forward. This brings the tongue forward and opens the airway. The devices are adjustable and can be customized according to patients’ needs.

As a result of prolonged pressure on the teeth, some individuals may experience movement of the teeth or discomfort of the jaw joint (TMJ). However, individuals without pre-existing problems with TMJ typically don’t experience any negative side effects after wearing the appliance.

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Maxillomandibular Advancement. This surgical procedure involves moving the upper teeth/bone and jaw forward as a unit. Moving the bone forward causes the airway muscles that are attached to the jaw and bony palate to pull away from the back of the throat. As a result, both the tongue and soft palate are moved forward, enabling major movement of the muscles of the airway. This technique is most suited for patients with severe sleep apnea. But because the surgery is extensive, the recovery time is prolonged.

Upper Airway Stimulation Therapy. The hypoglossal nerve stimulator is an implanted medical device that sends an electrical pulse to the nerve controlling tongue movement. Every time an individual takes a breath in their sleep, the device delivers a stimulus to the tongue that forces the airway to open.

Patients who cannot tolerate CPAP, are not significantly overweight (BMI <35), have 15 to 65 blockages per hour in their throat (AHI 15-65), and do not have a high percentage of central apneas, may qualify for this treatment. Once the patient is evaluated by a sleep surgeon and determined to be a possible candidate, they are scheduled for a drug-induced sleep endoscopy. If the procedure shows that the patient’s airway collapses in a complete circle (concentric collapse), they are unlikely to benefit from this type of therapy. Patients with other types of collapse are more likely to experience relief from this therapy.

The surgically-implanted stimulator is composed of three elements. The generator, which is implanted under the skin and on top of the chest muscles, provides the stimulus to the nerve. A sensor with a wire connected to the generator is placed in the rib cage and is responsible for signaling to the generator that the patient is about to take a breath. A second wire with an electrode wrapped around the nerve connected to the patient’s tongue (hypoglossal nerve) is also connected to the generator. This second wire will help activate the nerve and open up the airway.

After the surgery is completed, the stimulator can be adjusted and fine-tuned according to patients’ unique needs. Patients will be provided with a remote controller to turn the device on and off, or pause the therapy briefly during the night.