Genioplasty for Sleep Apnea Correction

How can obstructive sleep apnea be corrected?

Obstructive sleep apnea (OSA) is a common condition, which is linked to an increased incidence of cardiovascular diseases, endocrine disorders, and overall increased healthcare utilization. Multi-level surgery has been established as the mainstay of treatment for the surgical management of obstructive sleep apnea. Skeletal surgery for OSA has traditionally consisted of a phased protocol to address airway obstruction secondary to both naso-, oro- and hypopharyngeal obstruction. Combined with a uvulopalatopharyngoplasty (UPPP), tongue base surgeries including the genioglossus advancement (GA), sliding genioplasty (SG), and hyoid myotomy and suspension have been developed to target hypopharyngeal obstruction.

What is a Sliding Genioplasty?

Sliding Genioplasty Technique

The sliding genioplasty is an lower jaw advancement genioplasty that is occasionally recommended for patients with microgenia. These patients have both a retrognathic and shortened mandible. Patients in whom the Geniotubercle Advancement cannot be performed due to increased risk for tooth injury or in patients with significant retrognathia greater than 2 cm from the subnasale vertical tangent may be considered for SG. The SG procedure seldom includes the entire genial tubercle, thereby not affecting pull on the genioglossal muscle. It will likely pull the geniohyoid muscle that may lead to an unfavorable vector on the tongue base. The procedure may be amenable for patients with retro-epiglottic obstruction. The SG is performed through subperiosteal dissection with exposure of the inferior border of the anterior mandible. A reciprocating saw is used to cut both lateral edges of the parasymphysis along its inferior border and then laterally tapering the cut below the the mental neurovascular bundles. The SG operation is often performed for both functional and aesthetic concerns. When the anterior osteotomy incorporates the geniotubercle through adjacent vertical window osteotomies, the operation is described as a mortised genioplasty. A patient with mild OSA with microgenia and nasal obstruction is depicted with postoperative cure in her OSA after functional rhinoplasty and sliding genioplasty.

Sliding Genioplasty Before and After Photos