Inferior Sagittal Osteotomy With Hyoid Bone Suspension for Obese Patients With Sleep Apnea

Ramirez, Sylvester G.; Loube, Daniel I.

doi:10.1001/archotol.1996.01890210031008

Cited by 74 publications

(44 citation statements)

References 16 publications

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“…A PAS below 7mm indicates hypopharynx obstruction 14 and when it comes associated with an H_PM distance greater than 20mm, the patient has severe mandibular retrognatism 3,6,10,13,14 . Our results showed that a pre and postoperative PAS of 7.9±2.3mm and 10.8±2.5mm, respectively, indicate a statistically significant increase (p < 0.001).…”

Section: Discussionmentioning

confidence: 99%

“…Many treatment success parameters are described in the literature; 7,12,14,17 however the majority of those used are HAI and minimum SaO 2 values, especially pre and postoperative values comparison. Riley et al 17 carried out an advance in the genioglossal muscle and myotomy elevating the hyoid bone in 55 patients, and considered a successful treatment those patients that had a minimum SaO2 > 90%, HAI < 20 or a 50% reduction in initial HAI: success rate based on these issues was of 67%.…”

Section: Discussionmentioning

confidence: 99%

“…Riley et al 17 carried out an advance in the genioglossal muscle and myotomy elevating the hyoid bone in 55 patients, and considered a successful treatment those patients that had a minimum SaO2 > 90%, HAI < 20 or a 50% reduction in initial HAI: success rate based on these issues was of 67%. Ramirez & Loube 14 carried out genioglossal advance, hyoid bone elevation and uvulopalatopharyngoplasty in non-obese patients and, by using the same parameters had a success rate of 42%. Johnson & Chinn 12 considered the treatment to be of clinical success when the postoperative HAI is below 5 and 10, or with a 50% reduction in initial HAI/ they had a success rate of 66% and 78%, respectively, in a HAI < 5 and HAI < 10; and 78% of success rate when 50% reduction in initial HAI was the criterion chosen.…”

Section: Discussionmentioning

confidence: 99%

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Mentoplastia para avanço do músculo genioglosso em pacientes com síndrome da apnéia-hipopnéia do sono obstrutiva e retrognatismo mandibular

Santos

Abrahão

Gregório

et al. 2007

Rev. Bras. Otorrinolaringol.

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A Síndrome da Apnéia-Hipopnéia do Sono Obstrutiva (SAHSO) é um doença de fisiopatologia complexa, e sua etiologia é multifatorial e não entendida completamente. Cirurgia com avanço do músculo genioglosso é indicado em obstrução na região de hipofaringe. OBJETIVO: Avaliar a eficácia e complicações da técnica de mentoplastia para avanço do músculo genioglosso em pacientes com síndrome da apnéia-hipopnéia do sono obstrutiva (SAHSO). MÉTODOS: Polissonografia, exame físico e análise cefalométrica foram realizados em 10 pacientes não-obesos, que apresentavam SAHSO leve ou moderada, índice de apnéia-hipopnéia (IAH) entre 5 e 30, obstrução de hipofaringe e retrognatismo mandibular. RESULTADOS: IAH pré-operatório médio foi de 12,4±4,6 diminuindo a média pós-operatória para 4,4±5,7 (p < 0,001). Quando 50% de redução do IAH pré-operatório foram escolhidos como parâmetro, o índice de sucesso foi de 70%. A análise cefalométrica revelou um aumento do espaço aéreo posterior (EAP) em todos os pacientes, a média pré-operatória foi de 7,9±2,3mm para uma média pós-operatória de 10,8±2,5mm (p < 0,001). CONCLUSÃO: Mentoplastia para avanço do músculo genioglosso parece reduzir os sinais da SAHSO, podendo ser considerada uma opção com tratamento cirúrgico em pacientes com obstrução na hipofaringe. Os dados coletados indicam esse procedimento como opção em pacientes com SAHSO e retrognatismo mandibular.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Mentoplastia para avanço do músculo genioglosso em pacientes com síndrome da apnéia-hipopnéia do sono obstrutiva e retrognatismo mandibular

Santos

Abrahão

Gregório

et al. 2007

Rev. Bras. Otorrinolaringol.

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“…Lee et al [28] showed that 23 of 35 patients (65.7%) had a postoperative RDI !20 after UPPP and GA without HM. Ramirez and Loube [29] in 1996 revealed in morbidly obese patients a 42% success rate by the phase I treatment using UPPP, GA, and HM. Utley et al [30] presented the results of phase I surgery using UPPP, GA, and HM in 14 patients, revealing a 57.1% (8/14) success rate, defined as a reduction in the RDI by 50% and a postoperative RDI of !20.…”

Section: Discussionmentioning

confidence: 99%

Contemporary Surgical Approaches to Upper Airway Reconstruction in Sleep-Disordered Breathing

Troell¹

2000

Otorhinolaryngol Nova

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Objective: To assess the efficacy of surgical approaches for upper airway reconstruction in simple snoring and sleep-disordered breathing, using laser-assisted uvulopalatoplasty (LAUP), uvulopalatopharyngoplasty (UPPP), genioglossus advancement, hyoid myotomy, and maxillomandibular osteotomy. Patients and Methods: A retrospective study of consecutively surgically treated patients with simple snoring or sleep-disordered breathing was performed. Twenty-two patients underwent treatment by LAUP, 23 by UPPP, and 12 by a phased surgical approach that included phase I surgery (UPP, genioglossus advancement, and hyoid myotomy) as the initial procedure and, if residual airway obstruction persisted, phase II surgery (maxillomandibular osteotomy). Results: The main outcome measures included improvement of excessive daytime sleepiness and improvement in objective sleep parameters: respiratory disturbance index (RDI) and lowest oxygen saturation (LSAT). For the patients undergoing phased airway reconstruction, the mean preoperative data included a RDI of 45.6, a LSAT of 80.9%, and an Epworth Sleepiness Scale score of 11.6. The responders of phase I surgery (7/11) revealed a change in the mean RDI from preoperatively to postoperatively of 32.0 to 3.6, LSAT of 82.6 to 91%, and Epworth Sleepiness Scale score of 9.3 to 6.8. The nonresponder group (4/11) revealed a change in the mean RDI of 69.3 to 55.6, LSAT of 78 to 77%, and Epworth Sleepiness Scale score of 14.0 to 7.7. Both patients undergoing phase II surgery were successfully treated. LAUP resolved snoring in 80.1% and UPPP in 90.9%. Conclusion: UPPP and LAUP are moderately effective procedures for resolving snoring. Phase I upper airway reconstruction using UPPP, genioglossus advancement, and hyoid suspension and phase II maxillomandibular advancement surgery offer a high surgical success rate in a disease that may need a stepwise approach to its management.

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“…Johnson and Chinn [60] reported excellent results in morbidly obese patients with AHIs up to 130. Ramirez and Loube [61] reported a 42% success rate in a series of 12 obese patients, including 40% with severe OSAS (AHI 160). Less encouraging results have been reported by other groups [59,62].…”

Section: Mandibular Osteotomy and Ga With Hmmentioning

confidence: 98%

Obstructive Sleep Apnea Syndrome and Snoring: What Is the Role of Surgery?

Pelletier¹,

Pellanda²,

Jaques³

2000

Otorhinolaryngol Nova

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This paper evaluates the different surgical treatments used in obstructive sleep apnea syndrome and snoring. This critical analysis is based on an extensive review of the literature and the authors’ experience. In snoring patients, the success rate of surgery focusing on the soft palate does not exceed 50–60%, and the risk of pharyngeal narrowing is high. Therefore, this treatment should be selectively performed. More conservative approaches are now under development. The surgical treatment of the obstructive sleep apnea syndrome is controversial. Surgery of the soft palate is associated with a high rate of complications and, therefore, is restricted to a limited number of cases. The compliance with continuous positive airway pressure is low, especially among young patients. Therefore, maxillofacial surgery has regained interest with two opposite concepts. Some authors favor a step-by-step approach, while others proceed in a one-stage surgery. The latter is more aggressive, but its success rate is superior (90%). Results and indications of hyoid myotomy and suspension associated with genioplasty (phase 1) and maxillomandibular osteotomy and advancement (phase 2) are reviewed in detail.

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Inferior Sagittal Osteotomy With Hyoid Bone Suspension for Obese Patients With Sleep Apnea

Cited by 74 publications

References 16 publications

Mentoplastia para avanço do músculo genioglosso em pacientes com síndrome da apnéia-hipopnéia do sono obstrutiva e retrognatismo mandibular

Mentoplastia para avanço do músculo genioglosso em pacientes com síndrome da apnéia-hipopnéia do sono obstrutiva e retrognatismo mandibular

Contemporary Surgical Approaches to Upper Airway Reconstruction in Sleep-Disordered Breathing

Obstructive Sleep Apnea Syndrome and Snoring: What Is the Role of Surgery?

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