I started going through the education section of the board after I posted. Sometimes I hit a block and need to post something for feedback before the mental block will release and I can see what's right in front of me.
The rotation is clear, what was not clear to me is that MMA referred to both upper and lower jaws. For some reason I didn't parse "maxillomandibular" correctly to mean both jaws. Your clarification makes perfect sense, thank you @kavan.
I am going to attempt less invasive MSE first, which will likely require surgical assist, or homeoblock expansion as they come with the least risk.
OK, now that the 2 salient concepts about MMA and CCW-r are clearer, I'll build on that a bit more.
Maxillo-Mandibular Advancement (MMA) is usually the term used when the surgery is aimed at addressing sleep apnea where advancement of both jaws is needed to 'clear' the airways.
The other term used when BOTH jaws are displaced (in a variety of ways) is; 'Bi-max' surgery. Although both the terms refer to double jaw surgery, the term 'Bi-max' is broader in scope as to comprise quite a variety displacements aimed at balancing the jaws (facial balance) and bite. It can include both types of rotations, CCW-r and clockwise and both types of movement; forward and backwards.
The term; MMA comes from a time where they used to advance both jaws an equal amount to clear the airways. But for people who had HIGH angles of inclination of the occlusal plane and the mandibular plane, the advancement was over a high angle of inclination and due to that there was an 'unwanted' extra vertical displacement vector in order to get the horizontal displacement vector needed to clear the airways. (A 'forward' motion along a steep downwardly diagonal incline includes a downward vertical vector in addition to the horizontal displacement vector which is the one needed to open the airways.) So MMA where the advancement was along the persons inherent LINE of orientation could often kick up unwanted aesthetic results when their line of orientation was a steep diagonal. With advances in surgical techniques such as CCW-r via downgrafting the posterior maxilla, they are able to DECREASE a high angle of inclination as to achieve the wanted horizontal displacement vector and to minimize extra 'unwanted' vertical displacement. So, modern techniques include more CCW-r with the MMA, especially so in people with high angles of inclination. That helps not only open the airways more but also give better facial balance along with it.
With regard to palate expander devices used to broaden the upper arch, that's a lateral expansion--lateral with reference to looking at the front of the face, something to do when the palate is too narrow and/or high vaulted. It isn't something to do 'instead' of getting the MMA for sleep apnea. It can be part of an over-all plan. But the surgeon doing the MMA should be involved. With these surgeries, there is the orthodonture (braces to prep) along with other devices in addition to the surgery itself and all involved are part of a TEAM with intercommunication.
