Modified Genioglossus Advancement and Uvulopalatopharyngoplasty in Patients with Obstructive Sleep Apnea

Objective. To describe modification of the originally described genioglossus muscle advancement and its clinical assessment in the treatment of patients with obstructive sleep apnea. Study Design. Prospective study. Setting. University medical hospital. Subjects and Methods. Twenty-three patients with obstructive sleep apnea underwent modified genioglossus muscle advancement with uvulopalatopharyngoplasty. All patients were evaluated before and 6 months after surgery by history taking, clinical examination, Epworth Sleepiness Scale evaluation, fiber-optic nasopharyngoscopy, cephalometry, panoramic X-ray, and nocturnal polysomnography. Results. Postoperative mean +/- SD apnea-hypopnea index (AHI) decreased from 40.7 +/- 17.4 to 15.4 +/- 10.7 (P = .00; 95\% confidence interval {[}CI], 18.4 to 32.27). With a success rate defined as AHI <20 and a 50\% decrease in AHI of the preoperative value, the surgical success rate was 86.9\%. Cephalometry analysis showed a significant difference between preoperative and postoperative findings, including a posterior airway space that increased a mean +/- SD from 8.1 +/- 2.5 to 12.3 +/- 3.7 mm (P = .00; 95\% CI, -5.89 to -3.0), position of the mandible to the cranial base (SNB degree) that increased from 77.3 +/- 2.7 to 78.5 +/- 1.3 (P = .005; 95\% CI, -2.11 to -0.4), and improved palatal parameters. The mean (SD) average depth of the osteotomy and genioglossus advancement was 11.8 +/- 2.6 mm. None of the 23 patients had mandible fracture, aesthetic changes of the chin, or detachment of the advanced genioglossus muscle. Conclusion. The modification described in this technique permits complete and safe capture and advancement of the whole genioglossus muscle, leading to satisfactory expansion of the retrolingual airway without stripping, detachment of the advanced genioglossus muscle, mandible fracture, or aesthetic changes of the chin.