Abstract
Surgery continues to be a mainstay in the management of patients with obstructive sleep apnea. The only 100% cure for upper airway obstruction is the tracheostomy, first described for this use by Kuhlo et al 1 Kuhlo W. Doll E. Franck M.D. Erfolgreiche behandlungeines Pickwick syndromes durh eine dauertrachealkanule. Dtsch Med Wochenschr. 1969; 94: 1268 Crossref Scopus (122) Google Scholar in 1969. Because of the numerous comorbidities associated with tracheostomy, most patients are reluctant to undergo this procedure. The standard of care currently follows a 2-stage surgical approach, as put forth by the Riley-Powell Stanford protocol. 2 Riley R. Powell N. 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 Abstract Full Text PDF PubMed Scopus (126) Google Scholar Stage I involves a combinations of procedures including uvulopalatopharyngoplasty, nasal surgery, surgery of the base of the tongue, hyoid suspension, and anterior mandibular osteotomy with genioglossus muscle (GG) advancement. Stage II is used in those patients in whom Stage I fails, as evidenced by lack of improvement on polysomnography. Stage II surgery involves maxillomandibular advancement and has been shown to be highly successful.
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