Discussion

Abstract

Advancement of the lower border of the anterior mandible for the treatment of obstructive sleep apnea syndrome (OSAS) was first described in 1984. 1 Riley R Guilleminault C Powell N et al. Mandibular osteotomy and hyoid bone advancement for obstructive sleep apnea: A case report. Sleep. 1984; 7: 79 Crossref PubMed Scopus (120) Google Scholar The initial rationale for this surgical approach was based on the findings that patients with OSAS have decreased posterior airway space (PAS) and increased distance between the mandible and the hyoid. The initial version of the procedure was just a high sliding genioplasty to advance the genioglossus, geniohyoid, and the anterior belly of the digastric muscles. With increasing understanding that the genioglossus muscle plays an important role in nocturnal airway obstruction, 2 Remmers JE Degroot WJ Sauerland EK et al. Pathogensis of upper airway occlusion during sleep. J Appl Physiol. 1978; 44: 931 PubMed Google Scholar , 3 Mezzanotte WS Tangel DJ White DP Waking genioglossal electromyogram in sleep apnea patients versus normal controls (a neuromuscular compensatory mechanism). J Clin Invest. 1992; 89: 1571 Crossref PubMed Scopus (589) Google Scholar an extension superiorly to fully incorporate the genioglossus muscle was developed. Although Prinsell, 4 Prinsell JR Maxillomandibular advancement surgery in a site-specific treatment approach for obstructive sleep apnea in 50 consecutive patients. Chest. 1999; 116: 1519 Crossref PubMed Scopus (212) Google Scholar as well as Hendler et al recently described the “modified mortise genioplasty,” a similar osteotomy design has been previously published. 5 Powell NB Riley RW Obstructive sleep apnea. Orthognathic surgery perspectives, past, present and future. Oral Maxillofac Clin North Am. 1990; 2: 843 Google Scholar , 6 Powell NB Riley RW Guilleminault C The hypopharynx: Upper airway reconstruction in obstructive sleep apnea syndrome. in: Snoring and Obstructive Sleep Apnea (ed 2). Raven Press, New York, NY1994: 193-209 Google Scholar , 7 Riley RW Powell NB 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 PubMed Google Scholar