Usefulness of uvulopalatopharyngoplasty with genioglossus and hyoid advancement in the treatment of obstructive sleep apnea.
OBJECTIVE
To evaluate the usefulness of uvulopalatopharyngoplasty plus mandibular osteotomy with genioglossus and hyoid advancement in the treatment of obstructive sleep apnea syndrome (OSAS).


METHODS
Prospective study of 20 consecutive patients with OSAS.


METHODS
University medical center.


METHODS
Twenty OSAS patients with multilevel upper airway obstruction who refused continuous positive airway pressure treatment. All patients were evaluated before and 6 months after surgery by clinical history, the Epworth Sleepiness Scale, physical examination, fiberoptic nasopharyngoscopy combined with the Müller maneuver, cephalometric analysis, nocturnal polysomnography, and a second-night polysomnography with upper airway pressure recording during sleep. Surgery procedures were uvulopalatopharyngoplasty plus mandibular osteotomy with genioglossus and hyoid advancement. Surgical successful outcome was defined as an apnea-hypopnea index (AHI) lower than 20 plus subjective resolution of daytime symptoms.


METHODS
Surgical success rate.


RESULTS
Mean +/- SD AHI decreased from 60.5 +/- 16.5 to 44.6 +/- 27(P =.007), and CT90 (percentage of time with oxyhemoglobin saturation below 90%) decreased from 39.5% +/- 26% to 25.1% +/- 26.4% (P =.002). The overall surgical success rate was 35% but increased to 57% in patients with moderate OSAS (AHI, 41-60) and to 100% in mild OSAS (AHI, 21-40). In the group of severe OSAS, the success rate was 9%. Predictors of surgical outcome success were the AHI, CT90, stages 2 and 3-4 sleep percentages, and the cephalometric ANB angle (angle formed from the deepest point on the maxillary outer contour to the nasion to the deepest point on the outer mandibular contour).


CONCLUSIONS
Patients with mild and moderate OSAS and multilevel obstruction in the upper airway may benefit from uvulopalatopharyngoplasty plus genioglossus and hyoid advancement.
Vilaseca
Isabel
I
Otorhinolaryngology Service, Hospital Clínic de Barcelona, C/ Villarroel 170, Barcelona 08036, Spain. ivilasecag@seorl.org
Morelló
Antonio
A
Montserrat
Josep María
JM
Santamaría
Joan
J
Iranzo
Alex
A
D000328:Adult; D002508:Cephalometry; D006801:Humans; D008297:Male; D019186:Mandibular Advancement / Q000379:methods*; D008875:Middle Aged; D010027:Osteotomy; D010160:Palate, Soft / Q000601:surgery*; D010614:Pharynx / Q000601:surgery*; D017286:Polysomnography; D011446:Prospective Studies; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D018709:Statistics, Nonparametric