- Email: [email protected]
Combined Elliptical Window Genioglossus Advancement, Hyoid Bone Suspension, and Uvulopalatopharyngoplasty Decrease Apnea Hypopnea Index and Subjective Daytime Sleepiness in Obstructive Sleep Apnea
CRANIOMAXILLOFACIAL DEFORMITIES/COSMETIC SURGERY
Combined Elliptical Window Genioglossus Advancement, Hyoid Bone Suspension, and Uvulopalatopharyngoplasty Decrease Apnea Hypopnea Index and Subjective Daytime Sleepiness in Obstructive Sleep Apnea Joseph E. Cillo Jr, DMD, MPH, PhD,* Patrick S. Dalton, DMD,y and David J. Dattilo, DDSz Purpose: The objective and subjective outcomes of combined mandibular elliptical window genioglossus advancement, hyoid bone suspension, and uvulopalatopharyngoplasty procedures have not been evaluated. This study was conducted to evaluate postoperative changes in the apnea hypopnea index (AHI) and subjective daytime sleepiness with this combination of procedures in the surgical management of obstructive sleep apnea (OSA). Patients and Methods: This was a retrospective cohort analysis of patients who had undergone combined elliptical window genioglossus advancement, hyoid bone suspension, and uvulopalatopharyngoplasty performed at Allegheny General Hospital (Pittsburgh, PA) from July 1, 2006 through December 31, 2008 for polysomnogram-confirmed OSA. Inclusion criteria included patients who had undergone the combined elliptical window genioglossus advancement, hyoid bone suspension, and uvulopalatopharyngoplasty procedures with preoperative and minimum 6-month postoperative AHI and Epworth Sleepiness Scale (ESS). Statistical significance between mean differences of pre- and postoperative AHI and ESS was determined with the 2-tailed paired t test and 95% confidence intervals. Results: Thirteen male patients (average age, 43.0 2.4 yr; average follow-up, 18.0 3.6 months) were included in this study. There were statistically significant differences between mean pre- and postoperative AHI (28.3 vs 12.1; P < .05; mean change, 16.2; 57.2% decrease) and ESS (15.2 vs 6.3; P < .05; mean change, 8.9; 58.6% decrease). Conclusion:
The combined mandibular elliptical window genioglossus advancement, hyoid bone suspension, and uvulopalatopharyngoplasty procedures for the treatment of OSA decrease AHI and subjective daytime sleepiness. Ó 2013 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 71:1729-1732, 2013
Received from the Division of Oral and Maxillofacial Surgery, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA.
Address correspondence and reprint requests to Dr Cillo: Division of Oral and Maxillofacial Surgery, Allegheny General Hospital, Allegheny
*Assistant Professor and Program Director.
Health Network, Pittsburgh, PA 15212; e-mail: [email protected]
yResident.
Received October 24 2012
zDivision Director.
Accepted June 3 2013
Disclosure of Unlabeled and/or Investigational Product Usage: The authors discuss Mitek Anchor, which is a product unlabeled
Ó 2013 American Association of Oral and Maxillofacial Surgeons
by the FDA.
http://dx.doi.org/10.1016/j.joms.2013.06.001
0278-2391/13/00532-6$36.00/0
Conflict of Interest Disclosures: None of the authors reported any disclosures.
1729
1730 Obstructive sleep apnea (OSA) has been recognized as a major public health concern with potential consequences, including motor vehicle crashes, increased morbidity, and cognitive deficits that impair work efficiency.1 Multilevel upper airway surgery in the management of OSA has been shown to be an effective treatment modality.2-6 For example, Yin et al6 described how combined genioglossus advancement, hyoid suspension, and uvulopalatopharyngoplasty for the surgical treatment of severe OSA significantly decreased the apnea hypopnea index (AHI). A dilemma inherent in the traditional genioglossus advancement procedure is with individuals with a normal or prominent chin profile. Although traditional genioglossus advancement may significantly alter the chin profile, the combined procedure of elliptical window genioglossus advancement, hyoid suspension, and uvulopalatopharyngoplasty, as described by Dattilo and Aynechi,2 has been shown to successfully maintain the presurgical facial profile of the patient.7 However, the efficacy of combined elliptical window genioglossus advancement, hyoid bone suspension, and uvulopalatopharyngoplasty has not been investigated for subjective and objective outcome analyses. The purpose of this study was to assess the effectiveness of these combined procedures. The null hypothesis for this study was that the preoperative AHI and Epworth Sleepiness Scale (ESS) would be equal to the postoperative AHI and EES, with specific aims to evaluate mean postoperative changes in AHI and ESS.
Patients and Methods STUDY DESIGN/SAMPLE
To address the research purpose, a retrospective cohort analysis was designed and implemented. The study population was composed of all patients who presented for the evaluation and surgical management of polysomnogram-confirmed OSA (AHI >5, ESS >5) with combined elliptical window genioglossus advancement, hyoid bone suspension, and uvulopalatopharyngoplasty at Allegheny General Hospital (Pittsburgh, PA) from July 1, 2006 through June 31, 2008. Patients who had undergone this procedure had a reluctance to undergo maxillomandibular advancement or opted for this combination of procedures because of a normal or prominent chin profile. Because of its retrospective nature, this study had exemption approval from the institutional review board of Allegheny General Hospital and Allegheny Singer Research Institute.
COMBINED TREATMENT FOR OBSTRUCTIVE SLEEP APNEA
by an overnight-attended polysomnogram. The ESS is defined as the score of the self-administered ESS used to assess subjective daytime sleepiness. The primary outcome (dependent) variables in this study were the average changes between pre- and postoperative AHI and ESS. The third category of variables was the demographics of the cohort (age and gender). DATA COLLECTION METHODS
Inclusion criteria for this study were any patient who had undergone combined elliptical window genioglossus advancement, hyoid bone suspension, and uvulopalatopharyngoplasty for polysomnogramconfirmed OSA (AHI >5, ESS >5) during the study period and had sufficient chart data for age, gender, time to last follow-up, and pre- and postoperative ($6 months) AHI and ESS. Exclusion criteria were any patient who did not have all 3 procedures performed simultaneously or did not have sufficient chart data for the variables assessed. PROCEDURE OVERVIEW
Under general anesthesia and after the completion of a standard uvulopalatopharyngoplasty procedure8 performed by the same head and neck surgeon, the combined elliptical window genioglossus advancement and hyoid bone suspension procedures, briefly, as described by Dattilo and Aynechi,2 are approached through an extraoral incision in the submental region and dissection is performed down to the hyoid bone, where 2 Mitek anchors (Mitek, Westwood, MA) are placed on the body of the hyoid bone. Through the same incision, an elliptical osteotomy is completed in the anterior mandible 15 and 5 mm from the inferior border and connected in an elliptical fashion. After completion of the osteotomy, the segment is rotated, fixated, and reduced, and the remaining bone is grafted back to the osteotomy site. Then, the hyoid suspension is completed and fixated to the mandible. DATA ANALYSES
The 2-way paired t test with 95% confidence intervals was used to evaluate differences in pre- and postoperative means for the AHI and ESS. Statistical significance was set at a P value lower than .05. An a priori power analysis was conducted for the 2-way paired t test to detect a 10% difference in mean AHI with an alpha value of 0.05 and a beta value of 0.8 (80% power).
Results VARIABLES
The primary independent variables in this study were the AHI and ESS. The AHI is defined as the average number of apneas and hypopneas per hour as determined
A priori power analysis for the 2-way paired t test for matched pairs (a = 0.05 and 80% power) required 13 patients. Thirteen consecutive patient charts that met the inclusion criteria for this study were evaluated.
1731
58.6 66.7 30.0 94.1 to 11.8
Cillo, Dalton, and Dattilo. Combined Treatment for Obstructive Sleep Apnea. J Oral Maxillofac Surg 2013.
Note: N = 13. Abbreviations: CI, confidence interval; AHI, apnea hypopnea index; ESS, Epworth Sleepiness Scale; SD, standard deviation.
8.9 9.0 4.5 16.0 to 2.0 <.05 15.0 to 3.0 6.3 5.0 3.9 1.0-15.0 57.2 64.3 37.9 88.9 to 16.4 Mean Median SD Range P value 95% CI
28.3 30.0 13.2 6.7-54.0
12.1 10.7 8.2 2.0-29.0
16.2 16.0 13.7 48.0 to 1.1 <.05 35.3 to 1.5
15.2 15.0 3.0 12.0-20.0
Percentage of Change Mean Change Postoperative ESS Percentage of Change
Preoperative ESS
The average age of the all-male cohort was 43.0 2.4 years (range, 38 to 49 yr; median, 44.5 yr). The average follow-up was 18 3.6 months (range, 6 to 36 months). The pre- and postoperative assessments of AHI and ESS are listed in Table 1.
Discussion
Mean Change Postoperative AHI Preoperative AHI
Table 1. ASSESSMENT OF PRE- AND POSTOPERATIVE APNEA HYPOPNEA INDEX AND SUBJECTIVE DAYTIME SLEEPINESS AFTER COMBINED MANDIBULAR ELLIPTICAL WINDOW GENIOGLOSSUS ADVANCEMENT, HYOID BONE SUSPENSION, AND UVULOPALATOPHARYNGOPLASTY FOR OBSTRUCTIVE SLEEP APNEA
CILLO, DALTON, AND DATTILO
The purpose of this study was to assess the effectiveness of the combined mandibular elliptical window genioglossus advancement, hyoid bone suspension, and uvulopalatopharyngoplasty procedures on OSA, with the null hypothesis that pre- and postoperative AHI and ESS would not be equal and a specific aim to compare average postoperative changes in AHI and ESS. The combined procedure of elliptical genioglossus advancement, hyoid suspension, and uvulopalatopharyngoplasty, as described by Dattilo and Aynechi,2 is a multilevel surgery designed to alleviate posterior upper airway obstruction in patients with OSA and simultaneously maintain the preoperative facial profile.7 The surgical management of OSA is considered successful if there is a decrease in AHI of 50%.9 Although the combination of procedures in this study did not decrease the AHI and ESS in every patient, as evidenced by the large range of each variable, on average it did significantly decrease these variables. The results of this study show that the combined procedure of elliptical window genioglossus advancement, hyoid suspension, and uvulopalatopharyngoplasty for OSA decreased the AHI an average of 57.2% and decreased subjective daytime sleepiness, as measured with the ESS, an average of 58.6%. These findings are consistent with those of other studies that evaluated combined traditional genioglossus advancement, hyoid suspension, and uvulopalatopharyngoplasty.6,10 The advantage of the elliptical window genioglossus advancement performed in this study is maintenance of the chin profile. As previously described,7 the elliptical window genioglossus advancement procedure maintains the preoperative chin profile position through its unique design with genioglossus advancement. In patients who are reluctant to undergo maxillomandibular advancement or who have a normal or prominent lower facial third profile, this combination of procedures may be a viable alternative in the surgical management of OSA. This study has the inherent flaws of a retrospective study, such as selection bias and an inability to control for confounding factors. In addition, this study was not able to assess the cohort’s postoperative need for, modification of, or elimination of continuous positive airway pressure use. To establish the external validity of the results in this study, prospective randomized multicenter clinical trials may be beneficial. In conclusion, combined elliptical window genioglossus advancement, hyoid suspension, and
1732 uvulopalatopharyngoplasty for the surgical management of OSA significantly decreased the AHI and ESS and may be considered a viable treatment option in patients with normal or prominent chin profiles. Further research also should involve quality-of-life issues and comparisons in randomized clinical trials against other contemporary treatment options, such as continuous positive airway pressure, oral airway appliances, and maxillomandibular advancement.
Press Release
COMBINED TREATMENT FOR OBSTRUCTIVE SLEEP APNEA
4.
5.
6.
7.
This article’s Press Release can be found, in the online version, at http://dx.doi.org/10.1016/j.joms.2013. 06.001.
8.
References
9.
1. Leger D, Bayon V, Laaban JP, et al: Impact of sleep apnea on economics. Sleep Med Rev 16:455, 2012 2. Dattilo DJ, Aynechi M: Modification of the anterior mandibular osteotomy for genioglossus advancement with hyoid suspension for obstructive sleep apnea. J Oral Maxillofac Surg 65:1876, 2007 3. Woodson BT, Steward DL, Mickelson S, et al: Multicenter study of a novel adjustable tongue-advancement device for
10.
obstructive sleep apnea. Otolaryngol Head Neck Surg 143: 585, 2010 Foltan R, Hoffmannova J, Pretl M, et al: Genioglossus advancement and hyoid myotomy in treating obstructive sleep apnoea syndrome—A follow-up study. J Craniomaxillofac Surg 35:246, 2007 Sorrenti G, Piccin O, Mondini S, et al: One-phase management of severe obstructive sleep apnea: Tongue base reduction with hyoepiglottoplasty plus uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg 135:906, 2006 Yin SK, Yi HL, Lu WY, et al: Genioglossus advancement and hyoid suspension plus uvulopalatopharyngoplasty for severe OSAHS. Otolaryngol Head Neck Surg 136:626, 2007 Cillo JE Jr, Thakker P, Dattilo DJ: Cephalometric soft tissue analysis of combined elliptical-window genioglossus advancement and hyoid suspension for obstructive sleep apnea. J Oral Maxillofac Surg 70:690, 2012 Labra A, Huerta-Delgado AD, Gutierrez-Sanchez C, et al: Uvulopalatopharyngoplasty and uvulopalatal flap for the treatment of snoring: Technique to avoid complications. J Otolaryngol Head Neck Surg 37:256, 2008 Hobson JC, Robinson S, Antic NA, et al: What is ‘ success’’ following surgery for obstructive sleep apnea? The effect of different polysomnographic scoring systems. Laryngoscope 122:1878, 2012 Richard W, Kox D, den Herder C, et al: One stage multilevel surgery (uvulopalatopharyngoplasty, hyoid suspension, radiofrequent ablation of the tongue base with/without genioglossus advancement), in obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol 264:439, 2007
Combined Elliptical Window Genioglossus Advancement, Hyoid Bone Suspension, and Uvulopalatopharyngoplasty Decrease Apnea Hypopnea Index and Subjective Daytime Sleepiness in Obstructive Sleep Apnea Joseph E. Cillo Jr, DMD, MPH, PhD,* Patrick S. Dalton, DMD,y and David J. Dattilo, DDSz Purpose: The objective and subjective outcomes of combined mandibular elliptical window genioglossus advancement, hyoid bone suspension, and uvulopalatopharyngoplasty procedures have not been evaluated. This study was conducted to evaluate postoperative changes in the apnea hypopnea index (AHI) and subjective daytime sleepiness with this combination of procedures in the surgical management of obstructive sleep apnea (OSA). Patients and Methods: This was a retrospective cohort analysis of patients who had undergone combined elliptical window genioglossus advancement, hyoid bone suspension, and uvulopalatopharyngoplasty performed at Allegheny General Hospital (Pittsburgh, PA) from July 1, 2006 through December 31, 2008 for polysomnogram-confirmed OSA. Inclusion criteria included patients who had undergone the combined elliptical window genioglossus advancement, hyoid bone suspension, and uvulopalatopharyngoplasty procedures with preoperative and minimum 6-month postoperative AHI and Epworth Sleepiness Scale (ESS). Statistical significance between mean differences of pre- and postoperative AHI and ESS was determined with the 2-tailed paired t test and 95% confidence intervals. Results: Thirteen male patients (average age, 43.0 2.4 yr; average follow-up, 18.0 3.6 months) were included in this study. There were statistically significant differences between mean pre- and postoperative AHI (28.3 vs 12.1; P < .05; mean change, 16.2; 57.2% decrease) and ESS (15.2 vs 6.3; P < .05; mean change, 8.9; 58.6% decrease). Conclusion:
The combined mandibular elliptical window genioglossus advancement, hyoid bone suspension, and uvulopalatopharyngoplasty procedures for the treatment of OSA decrease AHI and subjective daytime sleepiness. Ó 2013 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 71:1729-1732, 2013
Received from the Division of Oral and Maxillofacial Surgery, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA.
Address correspondence and reprint requests to Dr Cillo: Division of Oral and Maxillofacial Surgery, Allegheny General Hospital, Allegheny
*Assistant Professor and Program Director.
Health Network, Pittsburgh, PA 15212; e-mail: [email protected]
yResident.
Received October 24 2012
zDivision Director.
Accepted June 3 2013
Disclosure of Unlabeled and/or Investigational Product Usage: The authors discuss Mitek Anchor, which is a product unlabeled
Ó 2013 American Association of Oral and Maxillofacial Surgeons
by the FDA.
http://dx.doi.org/10.1016/j.joms.2013.06.001
0278-2391/13/00532-6$36.00/0
Conflict of Interest Disclosures: None of the authors reported any disclosures.
1729
1730 Obstructive sleep apnea (OSA) has been recognized as a major public health concern with potential consequences, including motor vehicle crashes, increased morbidity, and cognitive deficits that impair work efficiency.1 Multilevel upper airway surgery in the management of OSA has been shown to be an effective treatment modality.2-6 For example, Yin et al6 described how combined genioglossus advancement, hyoid suspension, and uvulopalatopharyngoplasty for the surgical treatment of severe OSA significantly decreased the apnea hypopnea index (AHI). A dilemma inherent in the traditional genioglossus advancement procedure is with individuals with a normal or prominent chin profile. Although traditional genioglossus advancement may significantly alter the chin profile, the combined procedure of elliptical window genioglossus advancement, hyoid suspension, and uvulopalatopharyngoplasty, as described by Dattilo and Aynechi,2 has been shown to successfully maintain the presurgical facial profile of the patient.7 However, the efficacy of combined elliptical window genioglossus advancement, hyoid bone suspension, and uvulopalatopharyngoplasty has not been investigated for subjective and objective outcome analyses. The purpose of this study was to assess the effectiveness of these combined procedures. The null hypothesis for this study was that the preoperative AHI and Epworth Sleepiness Scale (ESS) would be equal to the postoperative AHI and EES, with specific aims to evaluate mean postoperative changes in AHI and ESS.
Patients and Methods STUDY DESIGN/SAMPLE
To address the research purpose, a retrospective cohort analysis was designed and implemented. The study population was composed of all patients who presented for the evaluation and surgical management of polysomnogram-confirmed OSA (AHI >5, ESS >5) with combined elliptical window genioglossus advancement, hyoid bone suspension, and uvulopalatopharyngoplasty at Allegheny General Hospital (Pittsburgh, PA) from July 1, 2006 through June 31, 2008. Patients who had undergone this procedure had a reluctance to undergo maxillomandibular advancement or opted for this combination of procedures because of a normal or prominent chin profile. Because of its retrospective nature, this study had exemption approval from the institutional review board of Allegheny General Hospital and Allegheny Singer Research Institute.
COMBINED TREATMENT FOR OBSTRUCTIVE SLEEP APNEA
by an overnight-attended polysomnogram. The ESS is defined as the score of the self-administered ESS used to assess subjective daytime sleepiness. The primary outcome (dependent) variables in this study were the average changes between pre- and postoperative AHI and ESS. The third category of variables was the demographics of the cohort (age and gender). DATA COLLECTION METHODS
Inclusion criteria for this study were any patient who had undergone combined elliptical window genioglossus advancement, hyoid bone suspension, and uvulopalatopharyngoplasty for polysomnogramconfirmed OSA (AHI >5, ESS >5) during the study period and had sufficient chart data for age, gender, time to last follow-up, and pre- and postoperative ($6 months) AHI and ESS. Exclusion criteria were any patient who did not have all 3 procedures performed simultaneously or did not have sufficient chart data for the variables assessed. PROCEDURE OVERVIEW
Under general anesthesia and after the completion of a standard uvulopalatopharyngoplasty procedure8 performed by the same head and neck surgeon, the combined elliptical window genioglossus advancement and hyoid bone suspension procedures, briefly, as described by Dattilo and Aynechi,2 are approached through an extraoral incision in the submental region and dissection is performed down to the hyoid bone, where 2 Mitek anchors (Mitek, Westwood, MA) are placed on the body of the hyoid bone. Through the same incision, an elliptical osteotomy is completed in the anterior mandible 15 and 5 mm from the inferior border and connected in an elliptical fashion. After completion of the osteotomy, the segment is rotated, fixated, and reduced, and the remaining bone is grafted back to the osteotomy site. Then, the hyoid suspension is completed and fixated to the mandible. DATA ANALYSES
The 2-way paired t test with 95% confidence intervals was used to evaluate differences in pre- and postoperative means for the AHI and ESS. Statistical significance was set at a P value lower than .05. An a priori power analysis was conducted for the 2-way paired t test to detect a 10% difference in mean AHI with an alpha value of 0.05 and a beta value of 0.8 (80% power).
Results VARIABLES
The primary independent variables in this study were the AHI and ESS. The AHI is defined as the average number of apneas and hypopneas per hour as determined
A priori power analysis for the 2-way paired t test for matched pairs (a = 0.05 and 80% power) required 13 patients. Thirteen consecutive patient charts that met the inclusion criteria for this study were evaluated.
1731
58.6 66.7 30.0 94.1 to 11.8
Cillo, Dalton, and Dattilo. Combined Treatment for Obstructive Sleep Apnea. J Oral Maxillofac Surg 2013.
Note: N = 13. Abbreviations: CI, confidence interval; AHI, apnea hypopnea index; ESS, Epworth Sleepiness Scale; SD, standard deviation.
8.9 9.0 4.5 16.0 to 2.0 <.05 15.0 to 3.0 6.3 5.0 3.9 1.0-15.0 57.2 64.3 37.9 88.9 to 16.4 Mean Median SD Range P value 95% CI
28.3 30.0 13.2 6.7-54.0
12.1 10.7 8.2 2.0-29.0
16.2 16.0 13.7 48.0 to 1.1 <.05 35.3 to 1.5
15.2 15.0 3.0 12.0-20.0
Percentage of Change Mean Change Postoperative ESS Percentage of Change
Preoperative ESS
The average age of the all-male cohort was 43.0 2.4 years (range, 38 to 49 yr; median, 44.5 yr). The average follow-up was 18 3.6 months (range, 6 to 36 months). The pre- and postoperative assessments of AHI and ESS are listed in Table 1.
Discussion
Mean Change Postoperative AHI Preoperative AHI
Table 1. ASSESSMENT OF PRE- AND POSTOPERATIVE APNEA HYPOPNEA INDEX AND SUBJECTIVE DAYTIME SLEEPINESS AFTER COMBINED MANDIBULAR ELLIPTICAL WINDOW GENIOGLOSSUS ADVANCEMENT, HYOID BONE SUSPENSION, AND UVULOPALATOPHARYNGOPLASTY FOR OBSTRUCTIVE SLEEP APNEA
CILLO, DALTON, AND DATTILO
The purpose of this study was to assess the effectiveness of the combined mandibular elliptical window genioglossus advancement, hyoid bone suspension, and uvulopalatopharyngoplasty procedures on OSA, with the null hypothesis that pre- and postoperative AHI and ESS would not be equal and a specific aim to compare average postoperative changes in AHI and ESS. The combined procedure of elliptical genioglossus advancement, hyoid suspension, and uvulopalatopharyngoplasty, as described by Dattilo and Aynechi,2 is a multilevel surgery designed to alleviate posterior upper airway obstruction in patients with OSA and simultaneously maintain the preoperative facial profile.7 The surgical management of OSA is considered successful if there is a decrease in AHI of 50%.9 Although the combination of procedures in this study did not decrease the AHI and ESS in every patient, as evidenced by the large range of each variable, on average it did significantly decrease these variables. The results of this study show that the combined procedure of elliptical window genioglossus advancement, hyoid suspension, and uvulopalatopharyngoplasty for OSA decreased the AHI an average of 57.2% and decreased subjective daytime sleepiness, as measured with the ESS, an average of 58.6%. These findings are consistent with those of other studies that evaluated combined traditional genioglossus advancement, hyoid suspension, and uvulopalatopharyngoplasty.6,10 The advantage of the elliptical window genioglossus advancement performed in this study is maintenance of the chin profile. As previously described,7 the elliptical window genioglossus advancement procedure maintains the preoperative chin profile position through its unique design with genioglossus advancement. In patients who are reluctant to undergo maxillomandibular advancement or who have a normal or prominent lower facial third profile, this combination of procedures may be a viable alternative in the surgical management of OSA. This study has the inherent flaws of a retrospective study, such as selection bias and an inability to control for confounding factors. In addition, this study was not able to assess the cohort’s postoperative need for, modification of, or elimination of continuous positive airway pressure use. To establish the external validity of the results in this study, prospective randomized multicenter clinical trials may be beneficial. In conclusion, combined elliptical window genioglossus advancement, hyoid suspension, and
1732 uvulopalatopharyngoplasty for the surgical management of OSA significantly decreased the AHI and ESS and may be considered a viable treatment option in patients with normal or prominent chin profiles. Further research also should involve quality-of-life issues and comparisons in randomized clinical trials against other contemporary treatment options, such as continuous positive airway pressure, oral airway appliances, and maxillomandibular advancement.
Press Release
COMBINED TREATMENT FOR OBSTRUCTIVE SLEEP APNEA
4.
5.
6.
7.
This article’s Press Release can be found, in the online version, at http://dx.doi.org/10.1016/j.joms.2013. 06.001.
8.
References
9.
1. Leger D, Bayon V, Laaban JP, et al: Impact of sleep apnea on economics. Sleep Med Rev 16:455, 2012 2. Dattilo DJ, Aynechi M: Modification of the anterior mandibular osteotomy for genioglossus advancement with hyoid suspension for obstructive sleep apnea. J Oral Maxillofac Surg 65:1876, 2007 3. Woodson BT, Steward DL, Mickelson S, et al: Multicenter study of a novel adjustable tongue-advancement device for
10.
obstructive sleep apnea. Otolaryngol Head Neck Surg 143: 585, 2010 Foltan R, Hoffmannova J, Pretl M, et al: Genioglossus advancement and hyoid myotomy in treating obstructive sleep apnoea syndrome—A follow-up study. J Craniomaxillofac Surg 35:246, 2007 Sorrenti G, Piccin O, Mondini S, et al: One-phase management of severe obstructive sleep apnea: Tongue base reduction with hyoepiglottoplasty plus uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg 135:906, 2006 Yin SK, Yi HL, Lu WY, et al: Genioglossus advancement and hyoid suspension plus uvulopalatopharyngoplasty for severe OSAHS. Otolaryngol Head Neck Surg 136:626, 2007 Cillo JE Jr, Thakker P, Dattilo DJ: Cephalometric soft tissue analysis of combined elliptical-window genioglossus advancement and hyoid suspension for obstructive sleep apnea. J Oral Maxillofac Surg 70:690, 2012 Labra A, Huerta-Delgado AD, Gutierrez-Sanchez C, et al: Uvulopalatopharyngoplasty and uvulopalatal flap for the treatment of snoring: Technique to avoid complications. J Otolaryngol Head Neck Surg 37:256, 2008 Hobson JC, Robinson S, Antic NA, et al: What is ‘ success’’ following surgery for obstructive sleep apnea? The effect of different polysomnographic scoring systems. Laryngoscope 122:1878, 2012 Richard W, Kox D, den Herder C, et al: One stage multilevel surgery (uvulopalatopharyngoplasty, hyoid suspension, radiofrequent ablation of the tongue base with/without genioglossus advancement), in obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol 264:439, 2007