This article further delineates the options for hypopharyngeal OSA and describes the technique of genioglossus advancement to improve the tension in the tongue base. The authors take the reader through the relevant anatomy appropriate to the procedure and describe the technique as originally coined in 1984. They then subsequently walk you through the various alterations to this technique that have been described to avoid complications, most specifically the risk of mandibular fracture. They are supported with line drawings that aid the multitude of descriptions. Unfortunately, what becomes apparent is that there is no widely accepted technique with supporting evidence that demonstrates effectiveness of this sort of surgery. It suffers the same drawbacks as with hyoid suspension in that it is often combined with other surgical procedures for OSA, correcting other levels of collapse in addition. Case series are also small with varying definitions of surgical success. It still appears to be in the pioneering stage of development and with risks including bone necrosis and fracture, violation of dental roots and neurosensory changes. It is not recommended for the faint hearted!