RESUMEN
OBJECTIVE: To study the combined effect of modified genioglossus advancement (MGGA) and radiofrequency tongue base reduction (RFTBR) a long with anterolateral advancement (ALA) pharyngolplasty on OSA patients with retrolingual airway collapse. STUDY DESIGN: Prospective clinical study. SETTING: Zagazig and Benha Universities Medical Hospitals. PATIENTS AND METHODS: Twenty-one patients (21)with multilevel OSA underwent modified genioglossus advancement with radiofrequency tongue base reduction and anterolateral advancement pharyngolplasty. All patients were assessed before and 6 months after surgery by history talking, clinical examination, Epworth Sleepiness Scale evaluation fiberoptic examination during muller's maneuver, drug induced sleep endoscopy (DISE), panoramic X-ray, Cephalometry and polysomnography. RESULTS: Postoperative mean ± SD Epworth Sleepiness Scale (ESS) significantly decreased from 18.86 ± 2.03to 8.19 ± 1.86 (P-value was <0.001 95% (CI) 9.80 to 11.53).postoperative mean ± SD AHI decreased from 53.39 ± 14.10 to 26.66 ± 5.44 (P-value was <0.001 95% CI 22.37 to 32.81), postoperative mean ± SD LOS increased from 68.33 ± 9.12 to 86.0 ± 4.96 (P-value was <0.001 95% (CI) 15.24 to21.33).Based on cephalometric analysis postoperative mean ± SD PAS at mid retrolingual point in mm increased from 6.43 ± 1.25 to 11.98 ± 1.69 (P-value was <0.001 95% (CI) 4.78 to 6.32), also postoperative mean ± SD Distance between H-MP in mm decreased from 23.38 ± 1.14 to 15.17 ± 0.97 (P-value was 0.001 95% (CI) 7.66 to 8.76).The postoperative mean ± SD distance from hyoid to menton (H-me) in mm decreased from 39.47 ± 2.37to24.83 ± 2.43(P-value was 0.001 95% (CI) 7.31 to 8.41), the mean ± SD distance of genioglossus muscle advancement in mm was 14.45 ± 1.12.With a success rate defined as AHI < 20 and/or 50% reduction in AHI of the pre- operative value, the surgical success was 81%. CONCLUSION: MGGA with RFTBR along with anterolateral advancement pharyngoplasty in a single session is well tolerated and safe surgery in the treatment of multilevel OSA patients. It is effective in reducing respiratory parameters and subjective symptoms of OSA.