Hyoid Myotomy Research Articles

Medicare volume and reimbursement trends in lingual and hyoid procedures for obstructive sleep apnea

ObjectivesThis study aims to analyze utilization and reimbursement trends in lingual and hyoid surgery for obstructive sleep apnea (OSA). MethodsAnnual retrospective data on lingual and hyoid OSA surgeries was obtained from the 2000–2021 Medicare Part B National Summary Datafiles. Current Procedural Terminology (CPT) codes utilized included 21,685 (hyoid myotomy and suspension [HMS]), 41,512 (tongue base suspension [TBS]), 41,530 (radiofrequency ablation of the tongue [RFT]) and 42,870 (lingual tonsillectomy [LT]). ResultsThe number of lingual and hyoid OSA surgeries rose 2777 % from 121 in 2000 to 3481 in 2015, before falling 82.9 % to 594 in 2021. Accordingly, Medicare payments rose 17,899 % from an inflation-adjusted $46,958 in 2000 to $8.45 million in 2015, before falling drastically to $341,011 in 2021. As the number of HMSs (2000: 91; 2015: 84; 2021: 165), TBS (2009: 48; 2015: 31; 2021: 16), and LTs (2000: 121; 2015: 261; 2021: 234) only experienced modest changes in utilization, this change was largely driven by RFT (2009: 340; 2015: 3105; 2021: 179). Average Medicare payments for RFT rose from $1110 in 2009 to $2994 in 2015, before falling drastically to $737 in 2021. ConclusionLingual and hyoid surgery for OSA has overall fallen in utilization among the Medicare population from 2000 to 2021. However, there was a brief spike in usage, peaking in 2015, driven by the adoption (and then quick dismissal) of RFT. The rise and fall in RFT use coincide with the rise and fall in reimbursement.

Variables predictive of surgical outcomes after hyoid myotomy with suspension to thyroid cartilage

ObjectivesTo evaluate variables predicting improvement in obstructive sleep apnea (OSA) with hyoid suspension to thyroid cartilage 4-suture technique. MethodsSixty adult patients (age range 23–78 years) with OSA underwent hyoid suspension to thyroid cartilage with or without concurrent multi-level surgery over an eight-year period from 2011 to 2019 at a tertiary academic center. All patients had a preoperative apnea hypopnea index (AHI) ≥ 5. Changes in mean AHI, Epworth Sleepiness Scale (ESS), and lowest oxygen saturation (LSAT) were measured with paired Student t-test. Linear and logistic regression models were used to predict change in AHI and surgical success respectively with respect to body mass index (BMI), age, sex, previous sleep surgery, concurrent retrolingual surgery, concurrent palatopharyngoplasty, and preoperative AHI. ResultsThe mean AHI demonstrated a significant improvement from a preoperative AHI of 39.0 ± 25.5 to a postoperative AHI of 31.2 ± 23.4 (p = 0.005). The mean Epworth Sleepiness Score (ESS) significantly improved from 13.1 ± 6.0 to 9.2 ± 5.7 (p = 0.000012). Surgical success, defined as a 50% reduction in preoperative AHI to a postoperative AHI ≤ 20, was obtained in 18/60 (30.0%) patients. Preoperative BMI significantly correlates with variation of change in AHI in multivariable linear regression model (p = 0.003). Preoperative AHI was significant predictor of surgical success in multivariable logistic regression model. ConclusionThe magnitude of improvement in polysomnographic parameters after hyoid suspension to thyroid appears to be more significant in patients with lower BMI. Even patients with an obese BMI and severe OSA achieve significant improvement from this procedure.

Referral of adults with obstructive sleep apnea for surgical consultation: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment.

This systematic review provides supporting evidence for the accompanying clinical practice guideline on the referral of adults with obstructive sleep apnea (OSA) for surgical consultation. The American Academy of Sleep Medicine commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies that compared the use of upper airway sleep apnea surgery or bariatric surgery to no treatment as well as studies that reported on patient-important and physiologic outcomes pre- and postoperatively. Statistical analyses were performed to determine the clinical significance of using surgery to treat obstructive sleep apnea in adults. Finally, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process was used to assess the evidence for making recommendations. The literature search resulted in 274 studies that provided data suitable for statistical analyses. The analyses demonstrated that surgery as a rescue therapy results in a clinically significant reduction in excessive sleepiness, snoring, blood pressure (BP), apnea-hypopnea index (AHI), respiratory disturbance index (RDI), and oxygen desaturation index (ODI); an increase in lowest oxygen saturation (LSAT) and sleep quality; and an improvement in quality of life in adults with OSA who are intolerant or unaccepting of positive airway pressure (PAP) therapy. The analyses demonstrated that surgery as an adjunctive therapy results in a clinically significant reduction in optimal PAP pressure and improvement in PAP adherence in adults with OSA who are intolerant or unaccepting of PAP due to side effects associated with high pressure requirements. The analyses also demonstrated that surgery as an initial treatment results in a clinically significant reduction in AHI/RDI, sleepiness, snoring, BP, and ODI and an increase in LSAT in adults with OSA and major anatomical obstruction. Analysis of bariatric surgery data showed a clinically significant reduction in BP, AHI/RDI, sleepiness, snoring, optimal PAP level, BMI, and ODI and an increase in LSAT in adults with OSA and obesity. Analyses of very limited evidence suggested that upper airway surgery does not result in a clinically significant increase in risk of serious persistent adverse events and suggested that bariatric surgery may result in a clinically significant risk of iron malabsorption that may be managed with iron supplements. The task force provided a detailed summary of the evidence along with the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations. Kent D, Stanley J, Aurora RN, etal. Referral of adults with obstructive sleep apnea for surgical consultation: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med. 2021;17(12):2507-2531.

Hyoid Suspension With UPPP for the Treatment of Obstructive Sleep Apnea.

This retrospective evaluation of surgical outcomes for hyomandibular suspension when performed with uvulopalatopharyngoplasty (UPPP) for the treatment of obstructive sleep apnea (OSA). Thirty-nine patients with moderate-to-severe OSA were treated with hyoid myotomy and suspension and uvulopalatopharyngoplasty. Patients underwent hyoid advancement and suspension to the mandible (Encore System) with either staged or concurrent UPPP. The primary outcome was a successful surgical result, defined as an apnea hypopnea index (AHI) lower than 20, and a 50% or greater decline in AHI on postoperative polysomnography. Successful surgical results were achieved in 30 (76.9%) out of 39 patients. The mean preoperative AHI improved 69.2% from 49.9 ± 25.6 to 15.4 ± 14.9 (P < .001) postoperatively. All patients reported clinical improvement of symptoms. There were 4 wound complications and one infection requiring removal of hardware. For patients with multilevel obstructive sleep apnea, hyoid advancement and suspension to the mandible appears efficacious when performed in conjunction with uvulopalatopharyngoplasty.

The comparison of multilevel surgery (hyoid myotomy and suspension with uvulopalatopharyngoplasty) with CPAP in moderate to severe OSAS patients.

The study aimed to determine the efficacy of multilevel surgery (hyoid myotomy and suspension with uvulopalatopharyngoplasty) and continuous positive airway pressure (CPAP) for the treatment of moderate to severe obstructive sleep apnea syndrome (OSAS) and to clarify whether our surgical protocol could be as effective as CPAP. We conducted a case series study comparing the effects of multilevel surgery and CPAP in the same subjects to minimize the influence of confounding factors. Fifteen subjects were enrolled with a pretreatment apnea-hypopnea index (AHI) ≥ 15. Both CPAP and multilevel surgery could improve the AHI and oxygen desaturation index (ODI). The median AHI for baseline, CPAP and surgery were 38.9, 1.2 and 12.6, respectively (p < 0.001). The medina ODI for baseline, CPAP and surgery were 34.8, 0.9 and 7.2, respectively (p < 0.001). However, the results indicated CPAP as the more efficacious treatment modality compared with multilevel surgery. Moreover, CPAP not only decreased N1 sleep but also had beneficial effects on blood pressure control, whereas multilevel surgery did not have any significant difference. CPAP is efficacious in improving OSAS severity, oxygen desaturation, sleep stage, and blood pressure control; while hyoid myotomy and suspension with uvulopalatopharyngoplasty are only efficacious in improving OSAS severity and oxygen desaturation. This study suggested that CPAP is the first choice when considering treatment of OSAS, especially in patients with hypertension or other cardiovascular diseases.

Skeletal Surgery for Obstructive Sleep Apnea.

Multilevel surgery has been established as the mainstay of treatment for the surgical management of obstructive sleep apnea (OSA). Combined with uvulopalatopharyngoplasty, tongue-base surgeries, including the genioglossus advancement (GA), sliding genioplasty, and hyoid myotomy and suspension, have been developed to target hypopharyngeal obstruction. Total airway surgery consisting of maxillomandibular advancement (MMA) with/without GA has shown significant success. Skeletal procedures for OSA with or without a palatal procedure is a proven technique for relieving airway obstruction during sleep. A case study demonstrating the utility of virtual surgical planning for MMA surgery is presented.

The Incidence and Characterization of Globus Sensation, Dysphagia, and Odynophagia Following Surgery for Obstructive Sleep Apnea.

To determine the incidence, duration, and predictors of swallowing-related symptoms following upper airway surgery for obstructive sleep apnea. Adults (age 18 years or older) who underwent surgery for obstructive sleep apnea at a tertiary care institution from January 2012 to December 2015 were retrospectively reviewed. The incidence, duration, and associated factors of postoperative swallowing complaints were evaluated. A total of 130 patients (135 surgical encounters) met criteria for inclusion. There were 91 men (70.0%) and 39 women (30.0%) with a median age of 60 years (range: 19-79). Presurgical diagnosis of gastroesophageal reflux disease was present in 57 patients (43.8%). An average of 2.1 procedures (± 0.8) were conducted at each encounter. Uvulopalatopharyngoplasty (54.8%) was the most common followed by radiofrequency ablation of the soft palate (34.8%) and tongue base (29.6%). Postoperatively, 25 patients (19.8%) complained of dysphagia, 14 (10.9%) of globus, and 9 (6.7%) of odynophagia. Preoperative gastroesophageal reflux (odds ratio [OR] 4.09, 95% confidence interval [CI] 1.41-11.91) and hyoid myotomy with suspension (OR 4.88, 95% CI 1.34-17.77) were significant predictors for dysphagia. Radiofrequency ablation of the tongue base (OR 5.00, 95% CI 1.28-19.50) was a predictor for globus sensation. Median symptom durations, in months, were 4.0 for dysphagia, 7.3 for globus, and 3.0 for odynophagia. Preoperative gastroesophageal reflux and hyoid myotomy with suspension procedure were associated with postoperative dysphagia whereas radiofrequency ablation of the tongue base was associated with globus. These findings can assist surgeons in providing preoperative counseling and postoperative supportive measures regarding dysphagic symptoms following sleep surgery.

Hyoid myotomy and suspension without simultaneous palate or tongue base surgeryfor obstructive sleep apnea.

ObjectiveDetermine the effects of hyoid myotomy and suspension (HMS) without concurrent palatal or tongue base sleep surgery for obstructive sleep apnea (OSA).MethodPatients with OSA treated with HMS were identified using CPT code (21685) at an academic and private sleep surgery clinic. Those who underwent concurrent palatal or tongue base sleep surgery were excluded. Outcomes included simultaneous procedures, apnea-hypopnea index (AHI), lowest oxyhemoglobin saturation (LSAT), and Epworth Sleepiness Scale (ESS).ResultsNineteen patients with OSA underwent HMS without palatal or tongue base sleep surgery. The average age at surgery was (55.3 ± 13.5) years with a majority of patients being male (71%). Concurrent procedures included the following: torus mandibularis excision (n = 1), endoscopic sinus surgery (n = 4), septoplasty (n = 10), inferior turbinate reduction (n = 12), and nasal valve repair (n = 2). AHI improved significantly from (39.7 ± 21.2) events/h to (22.6 ± 22.7) events/h after HMS (P < 0.01), which represented a 43% reduction. LSAT significantly increased from (82.2% ± 9.9%) to (86.6% ± 6.2%), P < 0.01. There was no improvement in ESS after surgery (8.2 ± 4.4) to (8.3 ± 5.2), P = 0.904. A subset of patients with severe OSA (AHI > 30 events/h) had an improvement in AHI from (49.9 ± 16.6) events/h to (29.1 ± 24.9) events/h, P < 0.01.ConclusionHMS without palatal or tongue base sleep surgery improves OSA severity. It can be considered as a valid option in the treatment of OSA in appropriately-selected patients.

Hyoid surgery alone for obstructive sleep apnea: A systematic review and meta-analysis.

The primary objective was to determine if sleep study variables (e.g., apnea-hypopnea index [AHI] and lowest oxygen saturation) and quantitative sleepiness data improve following isolated hyoid surgery for obstructive sleep apnea (OSA). Systematic review and meta-analysis. Nine databases, including PubMed, were searched through September 5, 2015. Four hundred ninety-eight studies were screened, 64 were reviewed, and nine studies met inclusion criteria. A total of 101 patients were identified who underwent hyoid surgery alone for treatment of OSA. Subanalyses were performed for: 1) type of surgery, 2) primary versus secondary hyoid surgery, 3) positional versus nonpositional OSA, 4) age, and 5) body mass index. In patients undergoing isolated hyoid surgery, the AHI decreased from a mean ± standard deviation of 37.3 ± 21.1 (95% confidence interval [CI]: 33.1, 41.5) to 23.0 ± 18.6 (95% CI: 19.3, 26.7) events/hour, which correspond to a 38.3% reduction (P < .0001). AHI reduced by 38.3% for hyoid myotomy with suspension, by 50.7% for hyothyroidopexy, and by 7.1% for hyoid expansion. The Epworth Sleepiness Scale decreased by 3.2 points from 10.3 ± 4.9 (95% CI: 8.8, 11.8) to 7.1 ± 4.2 (95% CI: 5.8, 8.4; P = .0027). Isolated hyoid surgery has reduced OSA severity and improved sleepiness in adults. Hyothyroidopexy provided a 50.7% reduction in AHI, followed by hyoid myotomy with suspension (38.3% reduction in AHI) and hyoid expansion (7.1% reduction in AHI). The current literature lacks high-quality evidence with regard to hyoid surgery, and additional studies are needed to further elucidate the effect of hyoid surgery in OSA. NA Laryngoscope, 126:1702-1708, 2016.

Efficacy and mechanism of mandibular advancement devices for persistent sleep apnea after surgery: a prospective study.

BackgroundTo explore the feasibility, the efficacy, and the mechanism of mandibular advancement devices (MAD) in the treatment of persistent sleep apnea after surgery.MethodsNineteen patients who failed uvulopalatopharyngoplasty (UPPP) or UPPP plus genioglossus advancement and hyoid myotomy (GAHM) were given a non-adjustable MAD for treatment. All patients had polysomnography (PSG) at least 6 months post-UPPP with and without the MAD. Seventeen patients had computed tomography (CT) examinations.ResultsAfter the application of MAD, the apnea hypopnea index (AHI) decreased significantly from 41.2 ± 13.1/h to 10.1 ± 5.6/h in the responder group. The response rate was 57.9 % (11/19). During sleep apnea/hypopnea acquired from sedated sleep, the cross-sectional area and anterior-posterior and lateral diameters of the velopharynx enlarged significantly from 4.2 ± 6.0 mm2 to 17.5 ± 15.3 mm2, 1.9 ± 2.3 mm to 6.5 ± 4.1 mm, and 1.1 ± 1.3 mm to 2.6 ± 2.1 mm, respectively (P < 0.01) in the responder group with MAD. The velopharyngeal collapsibility also decreased significantly from 83.3 ± 21.8 % to 46.5 ± 27.1 %. The glossopharyngeal collapsibility decreased from 39.8 ± 39.1 % to −22.9 ± 73.2 % (P < 0.05).ConclusionMAD can be an effective alternative treatment for patients with moderate and severe OSAHS after surgery. The principal mechanisms underlying the effect of MAD are expansion of the lateral diameter of the velopharynx, the enlargement of the velopharyngeal area, the reduction of velopharyngeal and glossopharyngeal collapsibility, and the stabilization of the upper airway.

Adjustable Minimally Invasive Hyoid Myotomy and Suspension with Uvulopalatopharyngoplasty for the Treatment of Obstructive Sleep Apnea

Objectives: Examine the efficacy of minimally invasive hyoid myotomy and mandibular suspension with adjustable tensioning for hypopharyngeal obstruction in conjunction with uvulopalatopharyngoplasty in the surgical treatment of obstructive sleep apnea. Methods: Retrospective chart review in a private practice. Twenty consecutive patients with multilevel obstructive sleep apnea over a 12-month period were included. Patients underwent hyoid myotomy and suspension and uvulopalatopharyngoplasty with or without tonsillectomy either staged or performed at the same time for those patients who had not undergone uvulopalatopharyngoplasty previously. The hyoid was suspended to the posterior surface of the mandible using the Siesta Encore system and desired tension set through a single small submental incision. Patients underwent clinical examination and sleep study prior to surgery and approximately 3 months postoperatively. The primary outcome was a successful surgical result, defined as respiratory distress index lower than 20, and 50% or greater decline in respiratory distress index, and no oxygen desaturations below 85% on the postoperative sleep study. Results: Nineteen (95%) of 20 patients achieved a successful outcome. The average preoperative respiratory disturbance index (RDI) was 52.7. The average postoperative RDI was 11.8 ( P &lt; .005). The average preoperative body mass index was 27.3. The average decrease in the RDI was 78%. All patients in the study reported clinical improvement of symptoms. There were 2 minor wound complications and no major complications. Conclusions: For patients with multilevel obstructive sleep apnea, minimally-invasive mandibular hyoid suspension appears to be highly efficacious for the treatment of hypopharyngeal airway obstruction when performed in conjunction with uvulopalatopharyngoplasty.

Hyoid advancement to the mandible (hyo-mandibular advancement)

Hyoid advancement to the mandible was first described in 1984, but was later abandoned by most surgeons for the easier to perform advancement to the laryngeal cartilage. New modifications of the hyo-mandibular advancement technique has made this approach easier to perform and are described in this paper. The hyo-mandibular advancement technique has a higher success rate for the treatment of sleep apnea, especially in women.

Outcomes of Hyoid Myotomy and Suspension Using a Mandibular Screw Suspension System

To review the outcomes of hyoid myotomy and suspension with a mandibular screw anchoring device. Case series with chart review. Academic and private sleep surgery clinics. The study is a consecutive case series of patients undergoing hyoid myotomy and suspension using a mandibular screw suspension device as part of multilevel treatment of obstructive sleep apnea (OSA). Outcomes of interest included complication rates, change in daytime sleepiness scores, and change in apnea-hypopnea index (AHI). Ten women and 23 men with a mean age of 54 years (range, 33-73 years) underwent hyoid myotomy and suspension using a mandibular screw suspension device. Four (12%) patients experienced minor complications, including neck seroma (3 patients) and tongue edema (1 patient). Epworth Sleepiness Scale scores fell from a preoperative median of 12 to a postoperative median of 6 (P = .002). Ten patients (30%) refused the postoperative sleep study. In the 23 patients who underwent postoperative sleep studies, AHI scores decreased from a preoperative mean ± SD of 40.9 ± 25.1 to 18.6 ± 21.2 postoperatively (P = .001). Ten patients (30%) achieved a postoperative AHI below 10. The Repose system was initially applied using a standard hyoid dissection but was later modified using a minimally invasive small incision (<2 cm) approach that demonstrated significantly fewer complications (P = .04). Hyoid myotomy and suspension with a mandibular screw anchor is an effective method with which to address hypopharyngeal collapse in multilevel surgery for OSA. The procedure can be performed with a small-incision, minimally invasive approach with minimal complications and patient morbidity.

An Alternative Technique for Genioglossus Muscle Advancement in Phase I Surgery in the Treatment of Obstructive Sleep Apnea

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.

Maxillomandibular Advancement Surgery for the Treatment of Moderate-Severe Obstructive Sleep Apnea: A Systematic Review

Maxillomandibular Advancement Surgery for the Treatment of Moderate-Severe Obstructive Sleep Apnea: A Systematic Review

Genioglossus advancement and hyoid myotomy in treating obstructive sleep apnoea syndrome – A follow-up study

To assess the success of genioglossus advancement and hyoid myotomy in the obstructive sleep apnoea syndrome (OSAS) therapy by comparing pre- and postoperative respiratory values during sleep. One of the surgical methods of widening the upper airways is to advance the spina mandibulae together with the genioglossus insertion. Thus the whole tongue is advanced, including its base. Hyoid myotomy itself, leads to a very unaesthetic filling up of soft tissues in the submental space. Therefore, the original window method of genioglossus advancement was modified and the so-called tenon and mortise genioplasty according to Delaire was applied. Thirty-one patients underwent genioglossus advancement by the modified genioplasty with hyoid myotomy (8 women and 23 men, mean age 53.2 years; range 35-69 years). Basic polysomnographic parameters were monitored (during sleep) before surgery and 7.3 months (range 3-6 months) postoperatively. The cumulative success rate was 74%. Subjective assessment of daily sleepiness using the Epworth scale dropped from preoperative 9.6 to 4.7. The average respiratory disturbance index decreased from 20.9 preoperatively to 10.3, the oxygen desaturation index dropped from 15.1 to 8.8, the average preoperative values of baseline oxygen saturation and average desaturation values had been 95.1% and 86.5%, respectively, and had increased postoperatively to 96.0% and 90.3%, respectively. On the average, preoperative desaturation lasted 36.7s whereas it lasted for 31.0 s postoperatively. Polysomonographic monitoring proved that changing the upper airways can favourably impact upon respiratory parameters during sleep in OSAS.

Outcomes of Hyoid Suspension for the Treatment of Obstructive Sleep Apnea

To examine the efficacy of hyoid myotomy and suspension as a treatment of hypopharyngeal obstruction in obstructive sleep apnea. Prospective, observational study. Academic medical center. Twenty-nine consecutive male patients with suspected hypopharyngeal obstruction Patients underwent hyoid suspension. Uvulopalatopharyngoplasty with or without tonsillectomy was performed at the same time for those patients who had not undergone this procedure previously. Patients underwent clinical examination and sleep study prior to surgery and approximately 1 year postoperatively. Primary outcome was a successful surgical result, defined as apnea-hypopnea index lower than 20, 50% or greater decline in apnea-hypopnea index, and no oxygen desaturations below 85% on the postoperative sleep study. Secondary outcomes included daytime sleepiness as determined by the Epworth Sleepiness Scale and the severity of snoring. Postoperative complications were also recorded. Only 5 (17%) of 29 patients achieved a successful outcome. The respiratory disturbance index did not change significantly for the group as a whole, although the lowest oxygen saturation did show some improvement. Hyoid suspension does not provide results equivalent to those reported for genioglossus advancement or multisession tongue radiofrequency. Hyoid suspension alone is not an efficacious treatment for hypopharyngeal airway obstruction in most patients with obstructive sleep apnea.

Effects of genioglossal muscle advancement on speech: An acoustic study of vowel sounds

The effects of the genioglossal muscle advancement on phonetic quality of speech were studied analyzing the acoustic features of vowel sounds. The study group consisted of 5 men suffering from partial upper airway obstruction during sleep. To prevent tongue base collapse, genioglossal muscle advancement was made with chin osteotomy without hyoid myotomy and suspension. The speech material consisted of 8 vowels produced in sentence context repeated 10 times before the operation, and 10 days and 6 weeks after the operation. The acoustic features of vowels were analyzed. The operation had no significant effects on vowel quality. Only for 2 of the subjects the pitches changed systematically due to the operation. According to the acoustic analysis, genioglossal muscle advancement with chin osteotomy has no effects on vowel production. Some short-term changes were observed, but these changes were highly individual. The operation seems to have no potential to change vowel production.

Genioglossus advancement and hyoid myotomy under local anesthesia.

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.

Genioglossus advancement and hyoid myotomy under local anesthesia

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.