We prospectively studied nine patients with the obstructive sleep apnea (OSA) syndrome with polysomnography before and after combined (seven simultaneous and two sequential) uvulopalatopharyngoplasty and inferior sagittal mandibular osteotomy with genioglossus advancement as treatment for OSA. All patients had failed to tolerate nasal continuous positive airway pressure and had a respiratory disturbance index (RDI) > or = 20. All patients were found to have disproportionate pharyngeal anatomy with airway narrowing by cephalometrograms and/or fiberoptic nasopharyngoscopy. Following surgery there were significant reductions in the average numbers of respiratory events and significant improvements in average oxygen saturation measurements. When RDIs < or = 5 and < or = 10 are chosen as objective success benchmarks, the success rates are 67 percent (6/9) and 78 percent (7/9), respectively.