Genioglossus advancement under local anesthesia for obstructive sleep apnea

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.