Skeletal Surgery in Obstructive Sleep Apnea

Skeletal surgery for obstructive sleep apnea (OSA) aims to provide more space for the soft tissue in the oropharynx to prevent airway collapse during sleep. Conventional surgical techniques include genioglossus advancement (GA), hyoid myotomy/suspension (HMS), and maxillomandibular advancement (MMA). GA and HMS are usually performed with soft tissue surgery and/or other skeletal surgery in a combined manner. These combined procedures seem to have a higher success rate. MMA employs a different conceptual approach, so called whole upper airway reconstruction, because MMA can widen the entire upper airway with one procedure. Various modifications of skeletal surgery have been reported. Surgical techniques, efficacy and complications of skeletal surgery with my opinions and comments are introduced in this review. Furthermore, limitations and considerations in skeletal surgery that sleep surgeons have to realize and overcome will be discussed in this review.