Maxillomandibular Advancement Guided by the Barcelona Line, a Facial Soft-Tissue Reference, in Patients with Obstructive Sleep Apnea: A Feasibility Study

Maxillomandibular advancement (MMA) represents an effective surgical treatment for individuals with obstructive sleep apnea (OSA) when conservative therapies fail. However, variability in surgical planning methods limits predictability and standardization of outcomes. This retrospective cohort study evaluated clinical and polysomnographic outcomes of MMA planned using the Barcelona Line (BL), and to explore the relationship between BL-guided skeletal positioning and treatment response in adult patients with moderate to severe OSA. Twenty-six consecutive patients (N = 26) underwent standardized virtual planning, surgery, and follow-up, with preoperative and postoperative polysomnography and three-dimensional CBCT analysis. Skeletal movements, upper airway changes, and sleep-related outcomes were assessed. Mean advancement at pogonion was 19.0 ± 4.7 mm. The apnea–hypopnea index decreased significantly from 45.8 ± 11.6 to 6.6 ± 6.6 events/h (mean relative reduction of 85.6 ± 10.9%). Treatment success was achieved in 25/26 patients (96.2%; 95% CI 81.1–99.3) and cure in 22/26 patients (84.6%; 95% CI 66.5–93.9). Daytime sleepiness improved, with ESS scores decreasing from 12.2 ± 1.2 to 1.5 ± 0.4. Total upper airway volume increased from 26.46 ± 2.88 mm3 to 45.32 ± 5.41 mm3. BL-guided MMA is a feasible planning approach associated with substantial clinical improvement in selected OSA patients. The results likely reflect a combination of surgical advancement magnitude and patient selection. Comparative studies are required to determine the independent contribution of the BL.