Publication:
Genioglossus advancement under local anesthesia for obstructive sleep apnea

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Issued Date

2002

Resource Type

Article

File Type

application/pdf

ISSN

13412051

Other identifier(s)

2-s2.0-0036740584

Rights Holder(s)

มหาวิทยาลัยศรีนครินทรวิโรฒ

Bibliographic Citation

International Medical Journal. Vol 9, No.3 (2002), p.215-219

Suggested Citation

Neruntarat C. Genioglossus advancement under local anesthesia for obstructive sleep apnea. International Medical Journal. Vol 9, No.3 (2002), p.215-219. Retrieved from: https://hdl.handle.net/20.500.14740/6702

Title

Genioglossus advancement under local anesthesia for obstructive sleep apnea

Author(s)

Neruntarat C.

Abstract

Objective: Upper airway obstruction of patients with obstructive sleep apnea (OSA) occurring during sleep can appear at multiple sites including the oropharynx and the hypopharynx. Results of genioglossus advancement (GA) in the treatment of hypopharyngeal obstruction have been successfully 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 GA for the treatment of OSA under local anesthesia. Materials and Methods: Twenty six OSA patients with hypopharyngeal obstruction underwent GA under local anesthesia. 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. Uvulopalatal flap was an adjunct surgical procedure for palatal obstruction. Patients had a mean age of 39.5 ± 4.9 years and a body mass index of 29.1 ± 2.5 kg/m2. Most of the patients were male. Data on patients were compared from preoperative to postoperative assessment points. Statistical analysis was performed using Student t test. Results: All patients tolerated the procedure well. The mean follow up was 6 months (range 4 - 8 months). The mean RDI decreased from 45.8 ± 9.7 to 15.5 ± 6.1 (p < 0.001) and the lowest oxygen saturation increased from 81.6 ± 4.1% to 88.5 ± 3.5% (p < 0.01). The Epworth sleepiness scale improved from 13.8 ± 2.4 to 8.3 ± 2.6 (p < 0.001) and snoring scale improved from 8.4 ± 1.8 to 3.6 ± 1.9 (p < 0.001). Postoperative complications included wound dehiscence in 4%, transient dysphagia in 4%, and transient paresthesia of lower jaw in 8%. 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 OSA patients who had reduction in respiratory disturbance index (RDI) of 50% or more and a RDI of 20 or less after surgery. By these criteria, 73% of the patients were regarded as having responded to GA. Conclusion: There were a reduction in RDI, an increase in oxygen saturation, and clinical improvements after GA. This procedure appears to be a safe, inexpensive and effective procedure, which can be performed under local anesthesia with a low chance of complications in carefully selected OSA patients with hypopharyngeal obstruction.

Subject(s)

Adult
 Anesthesia induction
 Article
 Clinical article
 Disease predisposition
 Dysphagia
 Endotracheal intubation
 Female
 Human
 Hypopharynx
 Inferior alveolar nerve
 Local anesthesia
 Male
 Nerve block
 Oropharynx
 Osteotomy
 Oxygen saturation
 Pain
 Paresthesia
 Patient selection
 Polysomnography
 Scoring system
 Sleep apnea syndrome
 Statistical analysis
 Student t test
 Surgical anatomy
 Surgical technique
 Tongue
 Upper respiratory tract obstruction
 Visual analog scale
 Wound dehiscence

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URI

https://hdl.handle.net/20.500.14740/6702

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Scopus: Year 1983-2021

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