Genioglossus Advancement & Hyoid Suspension

What does it involve?

It is done under general anaesthesia and from inside the mouth, through an incision between the lower lip and the gum. According to the SEORL-CCC consent form, the bone rectangle measures about 2 cm long and 1 cm high. The attachment of the genioglossus lies in the midline, about 10 mm below the tip of the roots of the lower front teeth and 10 mm above the lower edge of the mandible, which is why the cut is planned on the X-rays beforehand. It is often combined with hyoid bone suspension to also open the lowest part of the throat. The aim is to act on the anchor points, not to remove tissue.

Who is it for?

It is aimed at selected patients in whom the airway collapses because of the bony support or the position of the deep tongue muscles. The indication is decided individually after studying where and why the airway collapses, usually with examination and sleep endoscopy (DISE). It is not a first option for everyone. If what takes up the space is the tissue of the tongue base itself (the lingual tonsil or a large tongue base), the alternative is to reduce it, for example with transoral robotic surgery (TORS).

Recovery

In the first days it is normal to have pain in the operated area and in the tongue, and some difficulty swallowing; painkillers, antibiotics and anti-inflammatories are given for a few days. Food is liquid at first and then soft until healing is complete. The hospital stay varies with each case and is sometimes very short. A few weeks later the sleep study is repeated to check whether the apneas, the blood oxygen and the quality of sleep have improved.

Risks

These are the specific risks listed in the official consent form of the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC), in plain words:

• ·The most immediate and important complication is that the airway closes because of swelling or a haematoma (a collection of blood) in the floor of the mouth or the tongue; it sometimes requires a tracheotomy and a stay in intensive care.
• ·Tingling or numbness of the lower lip and lower teeth for several weeks.
• ·In one third of patients some loss of sensation remains in the teeth closest to the operation, and it can be permanent.
• ·A small change in the face because the chin moves forward, usually very small.
• ·Infection of the mandible, or the gum incision opening up (it usually heals on its own). Less often, damage to the roots of the lower teeth or to the nerves of the chin, and fracture of the mandible: the area is somewhat weaker if there is a later blow.
• ·Late infection with loss of a small piece of bone, or one of the fixation pieces coming out.

As a reference from a published series: in 31 patients operated on with genioglossus advancement and hyoid suspension, the wound opened in 3%, swallowing was temporarily difficult in 3% and the jaw felt temporarily numb in 6%; most had mild to moderate pain for 5 to 7 days.