For patients who do not improve following UPPP, or are not candidates for that procedure, maxillofacial surgical techniques have been developed to reduce airway obstruction at the base of the tongue, below the level of the palate and tonsils. Candidates for these procedures have severe obstructive sleep apnea and usually have short, thick necks. Genioglossal advancement pulls the base of the tongue forward by repositioning a muscle attached to the tongue. Hyoid suspension lifts the tongue and pulls it forward, opening the airway at the base of the tongue. The most radical surgical option for repositioning the tongue is maxillomandibular advancement, when the bones of the upper and lower jaw are cut and moved forward with the use of surgical plates and screws.