Obstructive sleep apnea may pose serious health problems due to its adverse effects. Those risks related to obstructive sleep apnea that may be encountered have an impact on the quality of life including from day time sleeplessness to fatal consequences. Usually multiple sites are encountered in cases presenting with hypnoic or apneic episodes. Oropharyngeal and hypopharyngeal levels are the causative sites with higher incidences. This feature lends the problem to be diagnosed and treated properly where in severe and/or refractory cases maxillomandibular advancement might be carried out to improve posterior airway space. The ultimate aim of maxillomandibular advancement is to volumetrically increase retropharyngeal airway space. Synchronous maxillomandibular advancement is executed in the form of Le Forte I and bilateral sagittal split osteotomies unless preexisting malocclusion dictates otherwise with or without advancement genioplasty. Distraction osteogenesis for bilateral or unilateral mandibular advancement may also be planned for selected cases to improve obstructive sleep apnea. It has also been reported that midfacial distraction osteogenesis can improve posterior pharyngeal airway thus ameliorate the condition. Skeletal surgery aims to reposition related structures so that at a certain extend volumetric changes in the oropharyngeal airway would improve the problem. In addition and even more crucial by pulling the soft tissues most notably the tongue considered as the major contributing factors.