Download PDF
Sleep Breath 2001; 05(4): 173-180
DOI: 10.1055/s-2001-18806
CASE REPORT

Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Mortised Genioplasty in the Treatment of Obstructive Sleep Apnea: An Historical Perspective and Modification of Design

Barry Hendler1,2,3 , Keith Silverstein2,3,8 , Helen Giannakopoulos1,2,3 , Bernard J. Costello4,5,6,7
  • 1Department of Oral and Maxillofacial Surgery at The University of Pennsylvania Medical Center
  • 2Children's Hospital of Philadelphia
  • 3The University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania
  • 4Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University of Pittsburgh
  • 5Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
  • 6Clinical Faculty, Otorhinolaryngology/Head and Neck Surgery, Georgetown University Medical Center, Washington, D.C.
  • 7Oral and Maxillofacial Surgery, Georgetown University Medical Center, Washington, D.C
  • 8private practice, Paoli, Pennsylvania
Further Information

Publication History

Publication Date:
05 December 2001 (online)

    Permissions and Reprints

ABSTRACT

We describe a modified technique for mortised genioglossus advancement for treating obstructive sleep apnea and review the history of osteotomies in this region. This new osteotomy technique allows for greater soft tissue advancement of the hypopharyngeal region. Anatomical data from a previous study were used to evaluate the dimensions of the anterior mandible and design an osteotomy that overcomes shortcomings of previous designs. These anatomic measurements enabled us to estimate the size and formulate a design utilized in the anterior mandible for the treatment of obstructive sleep apnea. We believe this design offers the greatest amount of muscular advancement by including genioglossus, geniohyoid, digastric, and mylohyoid. This advancement results in increasing the posterior airway space by volumetric expansion. Custom-designed fixation was utilized to increase stability laterally and decrease the risk of mandibular fracture. The design should be a significant aid in reconstruction of the hypopharyngeal airway in patients with obstructive sleep apnea.

KEYWORD

Obstructive sleep apnea - genioglossus - osteotomy - surgical treatment

REFERENCES

  • 1 Rojewski T E, Schuller D E, Clark R W. Video endoscopic determinations of the mechanism of obstruction in obstructive sleep apnea.  Otolaryngol Head Neck Surg . 1984;  92 127
    PubMedGoogle Scholar
  • 2 Shepard Jr W J, Geffer W B, Guilleminault C. Evaluation of upper airway in patients with obstructive sleep apnea.  Sleep . 1991;  14 361-371
    PubMedGoogle Scholar
  • 3 Leiter J C. Upper airway shape: is it important in the pathogenesis of obstructive sleep apnea?.  Am J Respir Crit Care Med . 1996;  153 894-898
    PubMedGoogle Scholar
  • 4 Riley R W, Powell N B, Guilleminault C. Inferior mandibular osteotomy and hyoid myotomy suspension for obstructive sleep apnea: a review of 55 patients.  J Oral Maxillofac Surg . 1989;  47 159-164
    PubMedGoogle Scholar
  • 5 Riley R W, Powell N B, Guilleminault C. Maxillofacial surgery and nasal CPAP. A comparison of treatment for OSAS.  Chest . 1990;  98 1421-1425
    PubMedGoogle Scholar
  • 6 Riley R W, Powell N B, Guilleminault C. Obstructive sleep apnea and the hyoid. A revised surgical procedure.  Otolaryngol Head Neck Surg . 1994;  111 717-721
    PubMedGoogle Scholar
  • 7 Onal E, Lopas M, O'Connor T D. Diaphragmatic and genioglossal electromyogram responses to CO2 rebreathing in humans.  J Appl Physiol: Respir Environ Exerc Physiol . 1981;  50(5) 1052-1055
    PubMedGoogle Scholar
  • 8 Suratt P, McTier R, Wilhoit S. Upper airway muscle activation is augmented in patients with obstructive sleep apnea compared with that in normal subjects.  Am Rev Respir Dis . 1989;  137 889-894
    PubMedGoogle Scholar
  • 9 Guilleminault C, Hill M W, Simmons F B, Dement W C. Obstructive sleep apnea: electromyelographic and fiberoptic studies.  Exp Neurol . 1978;  6 48-67
    PubMedGoogle Scholar
  • 10 Kuhol W, Doll E, Franck M C. Erfolgreiche behandlung eines Pickwick syndrome dutch eine duwertracheal kanule.  Dtsch Med Wocheschr . 1969;  94 1286-1290
    PubMedGoogle Scholar
  • 11 Conway W A, Victor L D, Magilligan D J, Fujita S, Zorick F J, Roth T. Adverse effects of tracheostomy for sleep apnea.  JAMA . 1981;  246 347-350
    CrossrefPubMedGoogle Scholar
  • 12 Ikematsu T. Study of snoring, fourth report: therapy.  J Jap Otorhinolaryngol . 1964;  64 434-435
    PubMedGoogle Scholar
  • 13 Fujita S, Conway W, Zorick F, Roth T. Surgical correction of anatomic abnormalities of obstructive sleep apnea syndrome: uvulopalatopharyngoplasty.  Otolaryngol Head Neck Surg . 1981;  89 923-934
    CrossrefPubMedGoogle Scholar
  • 14 Powell N, Guilleminault C, Riley R, Smith L. Mandibular advancement and obstructive sleep apnea syndrome.  Bull Eur Physiopathol Respir . 1983;  19 607-610
    PubMedGoogle Scholar
  • 15 Riley R, Guilleminault C, Powell N, Derman S. Mandibular osteotomy and hyoid bone advancement for obstructive sleep apnea.  Sleep . 1984;  7(1) 79-82
    PubMedGoogle Scholar
  • 16 Riley R W, Powell N B, Guilleminault C. Inferior sagittal osteotomy of the mandible with hyoid myotomy-suspension: a new procedure for obstructive sleep apnea.  Otolaryngol Head Neck Surg . 1986;  94 589-593
    PubMedGoogle Scholar
  • 17 Troell R J, Powell J B, Riley R W. Hypopharyngeal airway surgery for obstructive sleep apnea syndrome.  Respir Crit Care Med . 1998;  19 175-183
    PubMedGoogle Scholar
  • 18 Lee N R, Givens C D, Wilson J, Robins R B. Staged surgical treatment of obstructive sleep apnea syndrome: a review of 35 patients.  J Oral Maxillofac Surg . 1999;  57 382-385
    CrossrefPubMedGoogle Scholar
  • 19 Riley R W, Powell N B. Maxillofacial surgery and obstructive sleep apnea syndrome.  Otolaryngol Clin North Am . 1990;  23(4) 809-826
    PubMedGoogle Scholar
  • 20 Silverstein K E, Costello B J, Giannakopoulos H, Hendler B H. Genioglossus muscle attachments: an anatomic analysis and the implications for genioglossus advancement.  Oral Surg, Oral Med, Oral Pathol, Oral Radiol Endod . 2000;  90(6) 686-688
    CrossrefPubMedGoogle Scholar
  • 21 Mintz S, Ettinger A, Geist J, Geist R. A modified geniotomy technique for obstructive sleep apnea syndrome.  J Oral Maxillofac Surg . 1995;  53 1226-1228
    CrossrefPubMedGoogle Scholar
  • 22 Waite P D, Wooten V, Lachner J, Guyette R F. Maxillomandibular advancement surgery in 23 patients with obstructive sleep apnea syndrome.  J Oral Maxillofac Surg . 1989;  47 1256-1261
    PubMedGoogle Scholar
  • 23 Riley R W, Powell N B, Guilleminault C. Obstructive sleep apnea syndrome: a surgical protocol for dynamic upper airway reconstruction.  J Oral Maxillofac Surg . 1993;  51 743
    PubMedGoogle Scholar
  • 24 Riley R W, Powell N B, Guilleminault C. Maxillofacial surgery and obstructive sleep apnea: a review of 80 patients.  Otolaryngol Head Neck Surg . 1989;  101 354
    PubMedGoogle Scholar
  • 25 Riley R W, Powell N B, Guilleminault C. Maxillary, mandibular, and hyoid advancement for treatment of obstructive sleep apnea: a review of 40 patients.  J Oral Maxillofac Surg . 1990;  48 21
    PubMedGoogle Scholar
  • 26 McAndrew B, Strauss R A. Delayed muscle detachment after genial tubercle advancement in a patient with obstructive sleep apnea.  J Oral Maxillofac Surg . 2000;  58(9) 1040-1043
    CrossrefPubMedGoogle Scholar
  • 27 Hendler B H, Costello B J, Silverstein K E, Yen D, Goldberg A. An analysis of uvulopalatopharyngoplasty, genioglossus advancement and maxillo-mandibular advancement for the treatment of obstructive sleep apnea.  J Oral Max Surg . 2001;  59(8) 892-897
    PubMedGoogle Scholar
      >