Mandibular muscle attachments in genial advancement surgery for obstructive sleep apnea

Abstract

Objectives/Hypothesis Genioglossus advancement is performed in select patients with obstructive sleep apnea. Surgical techniques attempt to capture the genial tubercle of the mandible; however, measurements of the genioglossus, geniohyoid, and digastric muscles are poorly delineated. This investigation is the largest anatomic study exploring the muscles of genial advancement surgery and the first to quantitatively characterize muscular attachments relative to the tubercle, providing new insights from an anatomic perspective on optimizing muscular advancement. Study Design Cadaveric study. Methods Fifty‐three fresh cadaveric mandibles underwent dissection of the genial tubercle and genioglossus, geniohyoid, and digastric muscles. Results Genial tubercle, geniohyoid, and genioglossus mean height was 7.78 mm, 5.15 mm, and 6.11 mm, respectively. On average, the geniohyoid began 4.88 mm and ended 10.03 mm from the inferior border of the mandible; the genioglossus 11.91 mm and 18.01 mm, similarly. Intermuscular distance, if present, was 2.67 mm; the muscles overlapped in 28% of cadavers. The combined vertical height of the muscles at their mandibular attachment was 13.94 mm, significantly differing from the height of the genial tubercle. The left and right lateral insertion of the digastric muscles was 19.34 mm and 19.31 mm, respectively, from midline. Conclusions The variable range of muscle attachments suggests that genioglossal and geniohyoid attachments extend beyond the genial tubercle and may not originate concentrically from the tubercle, but overlap and lie in very close proximity. Mandibular anterior muscle attachments require anatomic accuracy and an effective operative evaluation of advancement before reproducible, clinically effective osteotomies can be recommended. Level of Evidence NA Laryngoscope, 129:2424–2429, 2019

Traumatic genial tubercle fracture: a case description with 9-month radiographic follow-up and a literature analysis

“…There was no noted limited tongue movement, dysphagia or airway obstruction. This might be explained by the anatomical possible variation that these muscles might not originate only from the genial tubercles, but rather extended beyond them on the lingual surface of the mandible (18). Further, action of these muscular fibers and healing of these muscles over time could be a potential reason for the noted anterior advancement of the fractured tubercle when comparing its position related to the mandible at different follow-up periods.…”

Cirugía de avance maxilo-mandibular como tratamiento alternativo del Apnea Obstructiva del Sueño: Revisión de Literatura.

“…Por consiguiente, se opta como otra alternativa de tratamiento a los (DAM), su empleo está indicado para pacientes con SAOS leve a moderado y aquellos que no soporten CPAP, pero debido a la indisposición del paciente, se considera como una de las mejores alternativas de tratamiento la cirugía de avance Máxilo Mandibular (AMM). 1,3,8,26,[28][29][30][31] La cirugía de AMM consiste en corregir las alteraciones anatómicas; en este caso para corregir el SAOS. El principal objetivo es brindar una armonización dentofacial con una funcionalidad adecuada, por medio de los procedimientos quirúrgicos con osteotomías y avances musculares, como el músculo geniogloso.…”

“…Su incidencia incrementa con la presencia de factores de riesgo como, tales como: sobrepeso, personas de la tercera edad, sexo masculino, antecedentes familiares, hipotiroidismo, anomalías específicas craneofaciales, entre otras. [1][2][3][4] Esta alteración del sueño se determina como pausas de la respiración mientras la persona duerme. Los síntomas que presenta dicho trastorno se asocia a la hipersomnia o somnolencia, que quiere decir un excesivo cansancio y sueño durante el día, también puede relacionarse junto con falta de memoria, rendimiento deficiente durante el día, cefalea e irritabilidad, en pocos casos podría presentarse insomnio.…”

“…Durante el sueño, el individuo presentará ronquidos intermitentes, apneas de 3 minutos aproximadamente, lo cual determina un sueño de baja calidad, es por ello que presentará somnolencia excesiva diurna. 1,[5][6][7]8,9 La paralización de las vías respiratorias bucofaríngeas causa hipoxia e hipercapnia, disminuyendo la calidad del sueño, como consecuencia del SAOS, puede provocar con el tiempo enfermedades cardiovasculares, alteraciones en los niveles de glucosa, somnolencia durante el día, y daño cognitivo. 3,6,10 Para el tratamiento del SAOS se debe determinar un correcto diagnóstico y pronóstico, con el fin de mejorar la calidad de vida del paciente.…”

Identification, morphometry and volumetric analysis of the genial tubercles in radiographic and tomographic examinations

“…The genial tubercles, also known as mental spines, are bone protuberances located in the medium mandibular line, in the lingual face, below the lower incisors and above the inferior edge of the mandible base, they are subdivided into superior and inferior tubercles [8,4,12,6].…”