Bastien Benbassat1, Clément Cambronne2, Adeline Gallini3,4, Patrick Chaynes5,6, Frédéric Lauwers5,7, Guillaume de Bonnecaze8,9. 1. Otolaryngology, Head and Neck Surgery Department, University Rangueil-Larrey Hospital, 24 Chemin de Pouvourville, 31059, Toulouse, France. 2. Department of Oral Surgery, University of Toulouse, 31000, Toulouse, France. 3. UMR1027, INSERM-University of Toulouse, Toulouse, France. 4. Department of Epidemiology and Public Health, Centre Hospitalier Universitaire Toulouse, 37 Allées Jules Guesdes, 31073, Toulouse, France. 5. Department of Anatomy, CHU Rangueil-Larrey, University of Toulouse, Toulouse, France. 6. Department of Neurosurgery, Pierre-Paul Riquet Hospital, University of Toulouse, 31059, Toulouse, France. 7. Department of Maxillofacial Surgery, Pierre-Paul Riquet Hospital, University of Toulouse, 31059, Toulouse, France. 8. Otolaryngology, Head and Neck Surgery Department, University Rangueil-Larrey Hospital, 24 Chemin de Pouvourville, 31059, Toulouse, France. debonnecaze.g@chu-toulouse.fr. 9. Department of Anatomy, CHU Rangueil-Larrey, University of Toulouse, Toulouse, France. debonnecaze.g@chu-toulouse.fr.
Abstract
INTRODUCTION: Supra-selective stimulation of the branches destined for the horizontal part of genioglossus muscle (GGh) could be a target of choice in the treatment of mild-to-severe obstructive sleep apnea syndrome. The main aim of our study was to assess a percutaneous method for the three-dimensional localisation of the terminal branches destined to GGh. MATERIALS AND METHODS: Twenty cadaveric hypoglossal nerves were dissected and included in the injection protocol. The distance between the posterior edge of the mandibular symphysis and the hyoid bone on the sagittal midline as the approximated distance of the geniohyoid muscle (dGH) was measured before any dissection. Methylene blue mixed with a thickening agent, was injected. The injection point was defined in relation to dGH, in an orthonormal coordinate system. For each dissection, we recorded the theoretical and the real (X, Y, Z) coordinates of GGh motor points and measured their distance to each other. RESULTS: X was accurately estimated. Y and Z were overestimated by + 5.34 ± 5.21 mm ([Formula: see text]) and + 4.79 ± 3.99 mm ([Formula: see text]) on average, respectively. We found a more significant difference between the theoretical and real Y and Z coordinates in the subgroup BMI < 25 kg/m2 (8.6 ± 4.5 mm and 6.9 ± 2.5 mm, respectively, p = 0.0009), and of Z in subgroup with dGH ≥ 50 mm (6.89 ± 3.26 mm, p = 0.0494). CONCLUSIONS: X can be estimated accurately using the relationship [Formula: see text]. Y seems to be related to BMI and Z may be estimated with the relationship [Formula: see text]. This three-dimensional localisation could be very helpful to facilitate placement of cuff electrodes to manage refractory sleep apnea.
INTRODUCTION: Supra-selective stimulation of the branches destined for the horizontal part of genioglossus muscle (GGh) could be a target of choice in the treatment of mild-to-severe obstructive sleep apnea syndrome. The main aim of our study was to assess a percutaneous method for the three-dimensional localisation of the terminal branches destined to GGh. MATERIALS AND METHODS: Twenty cadaveric hypoglossal nerves were dissected and included in the injection protocol. The distance between the posterior edge of the mandibular symphysis and the hyoid bone on the sagittal midline as the approximated distance of the geniohyoid muscle (dGH) was measured before any dissection. Methylene blue mixed with a thickening agent, was injected. The injection point was defined in relation to dGH, in an orthonormal coordinate system. For each dissection, we recorded the theoretical and the real (X, Y, Z) coordinates of GGh motor points and measured their distance to each other. RESULTS: X was accurately estimated. Y and Z were overestimated by + 5.34 ± 5.21 mm ([Formula: see text]) and + 4.79 ± 3.99 mm ([Formula: see text]) on average, respectively. We found a more significant difference between the theoretical and real Y and Z coordinates in the subgroup BMI < 25 kg/m2 (8.6 ± 4.5 mm and 6.9 ± 2.5 mm, respectively, p = 0.0009), and of Z in subgroup with dGH ≥ 50 mm (6.89 ± 3.26 mm, p = 0.0494). CONCLUSIONS: X can be estimated accurately using the relationship [Formula: see text]. Y seems to be related to BMI and Z may be estimated with the relationship [Formula: see text]. This three-dimensional localisation could be very helpful to facilitate placement of cuff electrodes to manage refractory sleep apnea.
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