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Position Statement: Tongue Based Procedures

Position Statement: Tongue Based Procedures

Genioglossus advancement and hyoid myotomy/suspension, whether performed separately or combined, are considered effective and non-investigational with proven clinical results when considered as part of the comprehensive surgical management of symptomatic adult patients with mild obstructive sleep apnea (OSA) and adult patients with moderate and severe OSA assessed as having tongue base or hypopharyngeal obstruction.

There are no studies reporting the results for stand-alone genioglossus advancement (GA). The most current available evidence, using Center for Evidence Based Medicine guidelines, for UPPP+GA and UPPP+GAHM (genioglossus advancement, hyoid myotomy) can be summarized below (Handler, 2013;1):

N151 (7 studies)454 (11 studies)
Study Evidence Levels6 level 4, 1 level 211 level 4
AHI Reduction55%58%
Surgical Success61%61%


  1. Handler E, Hamans E, Goldberg AN, Mickelson S. Tongue suspension: An evidence-based review and comparison to hypopharyngeal surgery for OSA. Laryngoscope. May 2013; (online) 31. doi:10.1002/lary.24187
  2. Emara TA, Omara TA, Shouman WM. Modified genioglossus advancement and uvulopalatopharyngoplasty in patients with obstructive sleep apnea. Otolaryngol Head Neck Surg. November 2011; 145(5):865-871.
  3. Bowden MT, Kezirian EJ, Utley D, Goode RL. Outcomes of hyoid suspension for the treatment of obstructive sleep apnea. Otolaryngol Head Neck Surg. May 2005; 131(5):440-445.
  4. Jacobowitz O. Palatal and tongue base surgery for surgical treatment of obstructive sleep apnea: a prospective study. Otolaryngol Head Neck Surg. August 2006; 135(2):258-264.
  5. Gillespie MB, Ayers CM, Nguyen SA, Abidin MR. Outcomes of hyoid myotomy and suspension using a mandibular screw suspension system. Otolaryngol Head Neck Surg. Feb 2011; 144(2):225-229.

Important Disclaimer Notice (Updated 7/31/14)

Position statements are approved by the American Academy of Otolaryngology—Head and Neck Surgery or Foundation (AAO-HNS/F) Boards of Directors and are typically generated from AAO-HNS/F committees. Once approved by the Academy or Foundation Board of Directors, they become official position statements and are added to the existing position statement library. In no sense do they represent a standard of care. The applicability of position statements, as guidance for a procedure, must be determined by the responsible physician in light of all the circumstances presented by the individual patient. Adherence to these clinical position statements will not ensure successful treatment in every situation. As with all AAO-HNS/F guidance, this position statement should not be deemed inclusive of all proper treatment decisions or methods of care, nor exclusive of other treatment decisions or methods of care reasonably directed to obtaining the same results. Position statements are not intended to and should not be treated as legal, medical, or business advice.