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Isabel Vilaseca, MD; Antonio Morelló, MD; Josep María Montserrat, MD; Joan Santamaría, MD; Alex Iranzo, MD

Arch Otolaryngol Head Neck Surg. 2002;128:435-440.

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

Design  Prospective study of 20 consecutive patients with OSAS.

Setting  University medical center.

Patients and Interventions  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.

Main Outcome Measure  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).

Conclusion  Patients with mild and moderate OSAS and multilevel obstruction in the upper airway may benefit from uvulopalatopharyngoplasty plus genioglossus and hyoid advancement.

From the Services of Otorhinolaryngology (Drs Vilaseca and Morelló), Pneumology (Dr Montserrat), and Neurology (Drs Santamaría and Iranzo), University of Barcelona, Hospital Clínic, Barcelona, Spain.

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