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Genioglossus Advancement in Sleep Apnea Surgery
1
Introduction
The genioglossus muscle originates from the genial tubercle, inserts posteriorly at the tip of the tongue and the dorsum of the tongue, and into the body of the hyoid bone ( Fig. 52.1 ). The fibers retract the tip of the tongue, depress the dorsum of the tongue, and move the hyoid in an anterosuperior direction. The muscle receives the majority of its blood supply from the bilateral lingual arteries and is innervated by cranial nerve XII. It serves as a dilator of the pharynx and is thought to play a major role in nocturnal airway obstruction. Genioglossus advancement surgery (GA) places tension on the tongue musculature to limit posterior displacement during sleep. This chapter serves to describe GA; however, the procedure has largely fallen out of favor and is only performed in specific circumstances. Several less invasive options are currently available with potentially greater effectiveness.
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Indications/Contraindications
Patient selection for GA includes adult patients with a Fujita type II (retropalatal and retrolingual) or type III (retrolingual) abnormality with evidence of moderate to severe obstructive sleep apnea (OSA) demonstrated by polysomnography and failure of conservative therapies (such as weight loss, dental appliances, or positive airway pressure) to resolve symptoms. Reasons to exclude potential candidates include poor cardiopulmonary health, inability to undergo general anesthesia, or Fujita type I abnormalities (retropalatal).
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