Delayed muscle detachment after genial tubercle advancement in a patient with obstructive sleep apnea

Abstract

The consequences and health implications of obstructive sleep apnea syndrome (OSAS) continue to evolve, as do the various treatments. However, no single universal treatment protocol has been established.1 Medical management of OSAS principally consists of weight loss, nasal continuous positive airway pressure (CPAP), and dental appliances.2 Surgical management has evolved over the past several decades into a variety of staged protocols that incorporate procedures aimed at eliminating obstruction in the nasal cavity, that caused by the soft palate or base of the tongue/ hypopharynx, and that related to deficiencies in the maxillofacial skeleton. The initial phase of treatment generally involves procedures on the soft palate, such as uvulopalatopharyngoplasty (UPPP) or laser-assisted uvulopalatoplasty (LAUP) performed alone or in combination with septoplasty or genial tubercle advancement osteotomy (with or without hyoid myotomy/ suspension). Patients failing this initial phase of treatment are then treated by maxillomandibular advancement or tracheostomy. The recent literature has suggested that skeletal osteotomies (maxillomandibular advancement) may be useful as the initial phase of treatment as well.1,3-6 This case report describes a complication in a patient in the initial phase of treatment who underwent a genial tubercle advancement and had spontaneous detachment of the genial musculature 11 days postoperatively. Report of Case