Skeletal Surgery in Obstructive Sleep Apnea

Sung Wan Kim

doi:10.7599/hmr.2013.33.4.233

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Kim: Skeletal Surgery in Obstructive Sleep Apnea

Review Article

Hanyang Medical Reviews 2013; 33(4): 233-238.

Published online: 25 November 2013

DOI: https://doi.org/10.7599/hmr.2013.33.4.233

Skeletal Surgery in Obstructive Sleep Apnea

Sung Wan Kim

Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University School of Medicine, Seoul, Korea.

Correspondence to: Sung Wan Kim. Department of ORL-HNS, Kyung Hee University Medical Center, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 130-872, Korea. Tel: +82-2-958-8474, Fax: +82-2-958-8470, drkimsw@hanmail.net

Received 25 August 2013 Revised 18 October 2013 Accepted 26 October 2013

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Skeletal surgery for obstructive sleep apnea (OSA) aims to provide more space for the soft tissue in the oropharynx to prevent airway collapse during sleep. Conventional surgical techniques include genioglossus advancement (GA), hyoid myotomy/suspension (HMS), and maxillomandibular advancement (MMA). GA and HMS are usually performed with soft tissue surgery and/or other skeletal surgery in a combined manner. These combined procedures seem to have a higher success rate. MMA employs a different conceptual approach, so called whole upper airway reconstruction, because MMA can widen the entire upper airway with one procedure. Various modifications of skeletal surgery have been reported. Surgical techniques, efficacy and complications of skeletal surgery with my opinions and comments are introduced in this review. Furthermore, limitations and considerations in skeletal surgery that sleep surgeons have to realize and overcome will be discussed in this review.

Keywords: Sleep Apnea, Obstructive, Mandibular Advancement, Surgery

Figures and Tables

Fig. 1

Geniotubercle advancement. Ref. 10 with permission from Ilchokak.

Fig. 2

Various modifications of genioglossus advancement. (A) mandibular trapezoid osteotomy (Repainted from Ref. 11), (B) elliptical window genioglossus advancement (Repainted from Ref. 12), (C) trephine osteotomy approach approach (Repainted from Ref. 13), (D) mortised genioplasty (Repainted from Ref. 14), (E) modified geniotubercle advancement (Repainted from Ref. 15), (F) anterior mandibular segmental advancement.

Fig. 3

Hyoid myotomy/suspension. Ref. 10 with permission from Ilchokak.

Fig. 4

Bimaxillary advancement. Ref. 10 with permission from Ilchokak.

Fig. 5

Modified bimaxillary advancement. Ref. 24 with permission from John Wiley and Sons.

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