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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, 20131):

                     UPPP+GA                UPPP+GAHM
N                 151 (7 studies)               454 (11 studies)
Study Evidence Levels              6 level 4, 1 level 2                   11 level 4
AHI Reduction                          55%                          58%
Surgical Success                          61%                          61%

 

This meta-analysis only included studies that used surgical success as defined as post-operative AHI below 20 and at least a 50% reduction in AHI. Of note, the most recent study of UPPP+GA by Emara et al in 20112 of 23 patients using a modified genioglossus advancement procedure yielded an 87% success rate.

The utility of hyoid myotomy/ suspension as a stand-alone procedure is limited with respect to AHI reduction. One prospective study of 29 patients who underwent stand-alone hyoid suspension or UPPP and hyoid suspension as the only hypopharyngeal surgery showed only a 17% success rate3. Another study of 37 patients who underwent multi-level surgery showed an overall 51% success rate in the group who had hyoid suspension versus a 40% success rate for those without hyoid suspension4.  A study of 33 patients who underwent hyoid myotomy using a mandibular screw suspension system had limited post-operative data but overall showed 30% of these patients achieved a post-operative AHI below 105.

Adopted 2014

References

  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.
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