Does Tension Matter? A Comparison of Genioglossus Advancement Using Tensiometry to Predict Successful Outcomes

Objective: Evaluate the role of tension on the genioglossus muscle in patients undergoing genioglossus advancement for obstructive sleep apnea. We hypothesize that decreased tension and increased bicortical mandibular width will result in successful postoperative outcomes. Method: Eleven patients underwent preoperative and postoperative polysomnography, nasal endoscopy, and subjective questionnaires. Intraoperatively, the bicortical width of the mandible and the force required to pull the window osteotomy forward was measured with a tensiometer. The preoperative and postoperative data collected was then compared against the intraoperative measurements. Results: All patients completed pre- and postoperative evaluation. 82% (9/11) of patients were responders, defined as a greater than 50% reduction in AHI to an absolute level less than 15 events/h with no oxygen desaturations on postoperative polysomnography below 85%. A total of 18% (2/11) were nonresponders. All patients who were responders demonstrated a relative decreased tension (grams) and increased mandibular width (millimeters) with a tension to width ratio of less than sixty. All non-responders had a tension to width ratio of greater than sixty. Further, patients with the lowest ratio demonstrated the greatest subjective and objective improvement based on sleep questionnaires and polysomnography. Conclusion: We conclude that decreased tension and increased mandibular width are positive predictive factors for postoperative success, and increased tension and narrow mandibular width are negative predictive factors for postoperative success. Thus, the tension to bicortical width ratio may be an independent predictor of postoperative success following genioglossus advancement.