DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Obstructive sleep apnea.
POSTOPERATIVE DIAGNOSIS: Obstructive sleep apnea.
OPERATIONS PERFORMED:
1. Hyoid suspension.
2. Anterior mandibular osteotomy with genioglossus muscle advancement.
SURGEON: John Doe, MD
ANESTHESIA: General.
ESTIMATED BLOOD LOSS: Less than 50 mL.
COMPLICATIONS: None.
INDICATIONS FOR OPERATION: This is a patient with obstructive sleep apnea and hypopharyngeal obstruction having failed previous UP3 surgery. After discussion of risks and benefits, including alternative treatment options, including repeat trials of nasal CPAP, the patient elected to proceed with hyoid suspension and genioglossus advancement. A preoperative Panorex was obtained and present in the operating room to assist with surgical landmarks, minimizing risks to teeth roots.
DESCRIPTION OF OPERATION: The patient was brought to the operating room and placed in the supine position, induced, and mask ventilated per Anesthesia. The patient was unable to be intubated using direct laryngoscopy. The patient was awakened and intubated through a fiberoptic technique. The table was turned, and after confirming the correct patient and procedure using standard time-out technique, the neck was prepped and draped in the usual sterile fashion.
A horizontal skin incision was made in a previously identified skin crease, and dissection was carried down to the subplatysmal plane, and flaps were elevated. The strap muscles were divided in the midline, exposing the thyroid cartilage and hyoid bone. Two 0-Prolene sutures were placed around the hyoid bone and through the right and left aspects of the superior thyroid cartilage bilaterally. The hyoid bone was advanced anteriorly and suspended to the thyroid cartilage using standard technique with the Prolene sutures. Hemostasis was obtained. The wound was irrigated with saline and closed in layers.
Attention was then turned to the genioglossus advancement. A mucosal incision was made in the gingival labial sulcus at the lower lip. Dissection was caried down through the mentalis muscles down to the mandibular periosteum. This was elevated to the inferior border of the mandible, exposing the mental foramen bilaterally with preservation of the inferior alveolar nerve bilaterally. The foramen served as the superior limit for the osteotomy. The inferior limit was placed 5 to 10 mm from the inferior border of the mandible to minimize risks of mandibular fracture. The osteotomy stayed medial to the canine nerve roots bilaterally. The osteotomy was difficult due to the thick portion of the mandible in this patient.
Following completion of the osteotomy, the bone segment was advanced anteriorly along with the genioglossus muscle attached posteriorly. It was rotated 90 degrees. The intervening medullary space and anterior mandibular cortex were removed, and the osteotomy segment was stabilized with a lag screw technique utilizing a 2 mm thick, 8 mm long screw. Hemostasis was obtained. The wound was closed in layers. The patient was returned to anesthesia care, awakened, extubated, and taken to the recovery room in good condition.
