Genioglossus advancement and hyoid myotomy under local anesthesia

Abstract

Obstructive sleep apnea syndrome (OSAS) is a common chronic illness that results in significant morbidity in many patients. Upper airway obstruction of OSAS patients occurring during sleep can appear at multiple sites, including the hypopharynx. Successful results of genioglossus advancement and hyoid myotomy with suspension (GAHM) in the treatment of hypopharyngeal obstruction have been reported when performed under general anesthesia. However, many patients have difficulty at induction of anesthesia and intubation. Patients are predisposed to specific complications, owing to anatomical abnormalities of the airway and existence of underlying syndrome. The purpose of this study was to assess the safety and efficacy of GAHM for the treatment of OSAS with the patient under local anesthesia. Thirty-one OSAS patients with hypopharyngeal obstruction underwent GAHM under local anesthesia. The inferior alveolar nerve was blocked. The osteotomized mandibular segment was advanced and turned to lock the inner surface of the mandible and geniotubercle at the outer surface. The hyoid bone was suspended to the superior aspect of the thyroid cartilage. Uvulopalatal flap was an adjunct surgical procedure for palatal obstruction. Patients had a mean age of 46.2 +/- 5.8 years and a body mass index of 28.8 +/- 3.2 kg/m(2). Most of the patients were male. Data on patients were compared between preoperative and postoperative assessment points. Statistical analysis was performed using Student's t test. All patients tolerated the procedure well. The mean follow-up was 8 months (range, 6 to 10 months). The mean Respiratory Disturbance Index (RDI) decreased from 48.2 +/- 10.8 to 14.5 +/- 5.8, and the lowest oxygen saturation increased from 81.8 +/- 3.8% to 88.8 +/- 2.9%. The Epworth Sleepiness Scale score improved from 14.9 +/- 2.3 to 8.2 +/- 1.7 (P < 0.001), and the snoring scale improved from 8.1 +/- 0.6 to 3.4 +/- 0.9 (P < 0.001). Postoperative complications included wound dehiscence in 3%, transient dysphagia in 3%, and transient paresthesia of the lower jaw in 6%. Bleeding, infection, and airway obstruction were not observed. Most patients had mild-to-moderate pain (visual analog scale, </=7) for 5 to 7 days after procedures. Responders were defined as OSAS patients who had a reduction in the RDI of >/=50% and an RDI of </=20 after surgery. By these criteria, 70% of the patients were regarded as having responded to GAHM. Significant reduction in RDI and clinical improvements in snoring and sleepiness were observed after GAHM. It appears to be a safe, inexpensive, and effective procedure that can be performed under local anesthesia with a low chance of complications in carefully selected OSAS patients.