Tongue Muscle (Genioglossus) Advancement

The genioglossus is a muscle of the human body that runs from the back of the chin (genial tubercles) to the tongue. It’s the largest muscle of the tongue. A relaxation of the genioglossus and geniohyoid (jaw/neck) muscles during sleep is implicated in Obstructive Sleep Apnea (OSA). The reason for this is that by relaxation of the tongue muscle during sleep, this muscle could obstruct the airway passage by falling backwards. In selected cases this problem can be alleviated by pulling the tongue muscle forward. This is done by pulling the bone below the front teeth of the lower jaw, in which the muscle is attached to, forward and securing it. This procedure would allow the bony support of tongue (genial tubercles) with their muscle attachments to be maximally advanced with minimal cosmetic change. This procedure is done entirely through the oral cavity and there are no incisions on the skin. This procedure does not change the esthetic chin position, move the jaws or teeth.

Success rates for Genioglossal advancement in obstructive sleep apnea patients are as low as 30% to as high as 65%. The success rate is multifactor but the main factors are the severity of sleep apnea and the anatomical location of blockage of air exchange. Research suggests that Genioglossal advancement is best suited for patients with abnormalities in the lower throat and tongue position with mild to moderate obstructive sleep apnea. Results are poor if the problems involve other anatomical locations such as the nasal cavity, upper throat and soft palate area. Research has shown the success rate of Genioglossal advancement increase up to 80% when this procedure is combined with soft palate procedures such as UPPP. Sometimes depending on the position of hyoid bone (bone supporting neck/ airway muscles), the genioglossus advancement procedure could be combined with hyoid suspension. By performing these procedures simultaneously, we are able to bring tongue forward opening the airway and stabilizing the hyoid bone in a more forward position.

Genioglossal advancement is preformed at a hospital setting under general anesthesia with 24 hours post surgical monitor or longer depending on patient’s medical condition and severity of obstructive sleep apnea. This procedure is also preformed at an out patient surgical setting with general anesthesia with 12 hours or less monitoring depending if the patient has mild obstructive sleep apnea with no morbid medical condition. Patients generally complain of mild pain and swelling, difficulty swallowing and changes in speech which is temporary. The procedure also has a number of potentially serious complications including:

• Infection. Preventive antibiotics administered an hour before surgery can help reduce this risk.
• Bleeding, this could potentially cause a blockage of airway
• Jaw fracture
• Sensory deficit of the chin, lip and lower teeth
• Damage to lower teeth, requiring extraction or root canal therapy
• Opening of the wounds
• Failure and recurrence of apnea. In such cases, patients with moderate to severe OSA are treated with CPAP or Double jaw advancements (MMO).
• Disengagement of muscle from bone.
• Transient speech and swallowing difficulty

In general, only a small percentage of patients experience serious complications. Many of these complications can be avoided with proper technique and experienced surgeon. A patient's health status, including presence of obesity and severity of obstructive sleep apnea, may also affect outcomes. For any further questions please schedule an appointment with our qualified doctors.