In patients with moderate to severe obstructive sleep apnea (OSA) who fail conventional management, orthognathic surgery—specifically maxillomandibular advancement (MMA)—has become a recognized therapeutic alternative. A maxillary wedge osteotomy, frequently executed in tandem with mandibular surgery, represents a surgical modality for addressing OSA. This case series documents six OSA patients lacking anteroposterior maxillary deficiency who received treatment via maxillary wedge osteotomy. A retrospective review was conducted of six consecutive patients who underwent maxillomandibular advancement (MMA) for obstructive sleep apnea (OSA), all operated on by a single surgeon between 2018 and 2024 at the Maxillofacial Surgery Unit of San Camillo-Forlanini Hospital in Rome, Italy. Patient evaluation employed a CAD/CAM-assisted protocol. Pre- and postoperative comparisons were drawn to gauge the intervention’s success in ameliorating OSA-related measures. The surgical plan, developed digitally, comprised maxillary wedge osteotomy and bilateral sagittal split osteotomies (BSSO) of the mandibular ramus. Pre- and postoperative CT imaging, together with 3D reconstructions produced via dedicated software, displayed a counterclockwise rotation of the occlusal plane, yielding roughly 13 mm of mandibular advancement. The CT scans indicated substantial airway volume expansion consequent to the skeletal shift. Airway volume grew from 20.665 ± 546 mm³ to 27.177 ± 446 mm³. Counterclockwise rotational orthognathic surgery without maxillary advancement has been shown to meaningfully enlarge the posterior pharyngeal space while achieving favorable aesthetic results.
