Orthodontist and sleep medicine specialist Dr. Joseph Yousefian explains why Maxillomandibular Advancement (MMA) doesn’t always resolve sleep apnea. Drawing on case studies and clinical experience, he highlights the procedure’s limitations and the importance of addressing nasal anatomy and TMJ health. Dr. Yousefian also introduces his patented expansion techniques—MANE, DAME, and MAPES—which have shown strong results in improving airway health. This conversation explores airway dynamics, skeletal development, and the value of a personalized, multi-faceted treatment approach.
Dr. Yousefian’s book: Pediatric Treatment of Sleep Apnea
Hear from Dr. Yousefian’s Patients
https://youtube.com/shorts/EvOC51YXxRE
JawHacks Official eBook
https://substack.com/@jawhacks
1-on-1 Chat with Ron
And More on the Website
Timestamps
00:00:00 – Intro & Airway Mechanics
00:01:10 – Why MMA Doesn’t Always Cure Sleep Apnea
00:03:40 – When MMA Surgery Isn’t Enough (19.9 AHI Case Study)
00:05:35 – The Critical Role of Turbinate Reduction in Airway Health
00:07:03 – Empty Nose Syndrome Risks & Turbinate Management
00:08:24 – Why Significant Expansion (7-10mm) Outperforms Minimal Expansion
00:10:50 – Nasal Cavity Architecture: Height, Width & Airflow Dynamics
00:12:00 – When Counterclockwise Rotation Isn’t Possible
00:14:20 – TMJ Complications After Surgery: Revision Challenges
00:15:25 – Challenges of MARPE After LeFort I Surgery
00:17:45 – Removing Plates for Successful Post-Surgical Expansion
00:19:34 – DOME Procedure (DANE): Preventing Unilateral Cheekbone Distraction
00:22:08 – MSDO to Expand Narrow Arch vs. Tongue Reduction Surgery
00:28:12 – 53.6 AHI & Mandibular Tori (Case Study)
00:32:10 – Tooth-Borne (with SARPE) vs. Bone-Borne Expansion Debate
00:35:05 – TMJ Health & MSDO Mandibular Expansion (Osteoarthritis Case)
00:40:34 – Why MMA Can Put Stress on the TMJ (Condylar Resorption)
00:46:40 – Airway Changes After MMA Surgery: Temporary Feeling of Constriction
00:48:28 – Distraction Technique After MMA (Unique Case Study)
00:50:01 – 38% Cure Rate from MMA vs. 92% from TTP (Teledontic-Telegnathic Protocol)
00:51:33 – MANE (Micro-implant Assisted Nasomaxillary Expansion) & DAME (Distraction Assisted Mandibular Expansion) aka MARPE & MSDO
00:53:42 – Lip Competence & Auto-Rotation of Mandible Through Orthodontic Treatment (Case Study)
00:58:52 – Protecting & Supporting Front Teeth: Importance of Arms in Expanders
01:01:00 – Managing Asymmetric Expansion & the Purpose of Molar Arms
01:05:00 – Severe Complications: Mid-Facial Asymmetry Case Study
01:09:05 – Double Vision Complication After Expansion
01:12:08 – Benefits of Tooth-Borne Combined with Bone-Borne Anchorage
01:13:10 – FME (Facegenics Mid-facial Expander) & Armless Expanders Discussion
01:19:54 – Dentoalveolar vs. Skeletal Changes & Why They Are Both Important
01:29:45 – Prof. Won Moon: The Originator of MARPE
01:31:45 – Proportional Expansion Between Maxilla and Mandible
01:33:00 – Why DAME (MSDO) Is Safe for the Condyles & TMJ
01:37:00 – Recovery from Asymmetric Expansio (Case Study)
01:38:50 – SFOT vs. DAME: Severity of Surgical Procedure
01:41:11 – Addressing Critique from Kasey Li on MSDO
01:43:02 – MAPE (Micro-implant Assisted Protraction Expansion) for Children
01:48:36 – MAPES (Micro-implant Assisted Protraction Expansion Surgery) for Adults
01:51:50 – MAPES: When MMA is Not an Option
01:53:04 – AGGA vs. MAPES: Controlled Advancement Without Teeth Flaring
01:56:43 – The Legendary Case & Vertical Control for Counterclockwise Rotation
01:58:25 – Teledentics: Medical Utilization of Dentistry for Sleep Apnea
01:59:12 – Restorative Dentistry: How Crowns Support Expansion Stability
02:01:50 – MAPES and Sensitivity of Front Teeth
02:03:15 – The Limitations of Treatments & The Risk-Benefit Ratio
02:05:00 – Dr. Yousefian’s Book: Pediatric Treatment of Sleep Apnea
NO MEDICAL OR DENTAL ADVICE. Ronald Ead and JAWHACKS, LLC, dba JawHacks (collectively, “we”) does not give medical advice. We are not licensed medical professionals. The information provided in this video is for educational and informational purposes only and should not be construed as medical advice. Always seek the guidance of a qualified healthcare provider with any questions you may have regarding your health or a medical condition. Reliance on any information provided in this video is solely at your own risk. We make no representations or warranties about the accuracy or completeness of the information presented. You should not use these materials to diagnose or treat any health issues, illnesses or diseases. In addition, we do not recommend or endorse any provider of health care or health-related products, items, or services.
