Hyoid Bone Suspension as a Part of Multilevel Surgery for Obstructive Sleep Apnea Syndrome

Abstract

Introduction Since oropharyngeal surgery alone is often insufficient to treat obstructive sleep apnea (OSA), advances have been developed in hypopharyngeal surgery. Objective To assess hyoid suspension surgery as part of a multilevel OSA surgery, also including palatal surgery. Methods The study included patients with OSA symptoms with apnea hypopnea index (AHI) > 15. They were scheduled for hyoid suspension after a nasoendoscopy during Müller maneuver and drug induced sleep endoscopy (DISE). All patients had body mass index (BMI) < 35 kg/m2. Hyoidothyroidopexy combined with tonsillectomy and palatal suspension was performed in all cases. Results The mean AHI dropped significantly ( p < 0.0001) from 68.4 ± 25.3 preoperatively to 25.6 ± 9.52 postoperatively. The mean lowest oxygen (O 2 ) saturation level increased significantly from 66.8 ± 11.3 to 83.2 ± 2.86 ( p < 0.0001). In addition, the snoring score significantly decreased ( p < 0.0001) from a preoperative mean of 3.4 ± 0.54 to 2 ± 0.7 at 6 months postoperatively. In regard to the Epworth sleepiness scale (ESS), it showed significant improvements ( p < 0.0001) as its mean diminished from 13.8 ± 5.4 preoperatively to 5.2 ± 1.6 postoperatively. Conclusion Hyoidothyroidopexy using absorbable suture seems to produce a good outcome in treating OSA. It could be effectively and safely combined with other palatal procedures in the multilevel surgery for OSA.

Expansion Hyoidthyroidpexy: Combined Hyoid Surgery Techniques for Obstructive Sleep Apnea: All in One

“…HTP, which has proven efficacy, was widely implemented, with several modifications and reports presented 2‐8,11‐16,18 . The present study supports the concept that surgeries at the HB might widen and support the hypopharyngeal airway space, thus preventing transversal collapse 1,5,8,10‐12 …”

“…[2][3][4][5][6][7][8][11][12][13][14][15][16]18 The present study supports the concept that surgeries at the HB might widen and support the hypopharyngeal airway space, thus preventing transversal collapse. 1,5,8,[10][11][12] We tried to combine all techniques of HS into a new one (Ex-HTP), so we could collect the advantages of all techniques in a single procedure within a reasonable operative time and minimal blood loss. Ex-HTP had not employed thyroid lamina miniplates, and no metal wires were used, thus avoiding its traumatic drawbacks to the thyroid cartilage and/or to the HB.…”

“…T his study provides a novel idea for patients with obstructive sleep apnea (OSA), for which the best surgical technique is yet to come. [1][2][3][4][5][6][7][8][9][10] The authors present a combination of the main hyoid procedures: subhyoid myotomy (SM), hyoid sectioning (HN), hyoidthryoidpexia (HTP), and expansion hyoidplasty (EH) in a single surgical technique (Ex-HTP). [11][12][13][14][15][16][17][18] To our knowledge, this is the first report of combined hyoid surgeries in human subjects without any devices, miniplates, or screws.…”

“…This study provides a novel idea for patients with obstructive sleep apnea (OSA), for which the best surgical technique is yet to come 1‐10 . The authors present a combination of the main hyoid procedures: subhyoid myotomy (SM), hyoid sectioning (HN), hyoidthryoidpexia (HTP), and expansion hyoidplasty (EH) in a single surgical technique (Ex‐HTP) 11‐18 …”

Cirugía del sueño: Definición de una especialidad emergente, propuesta de una clasificación anatomofuncional integral e indicaciones

“…Este grupo de procedimientos están dirigidos al manejo de los colapsos de VAS en los niveles orofaríngeo retrolingual-hipofaríngeo y laríngeo, pudiendo teóricamente estabilizar la lengua, paredes laterales hipofaríngeas y epiglotis 62,63 . Estas cirugías rara vez se realizan de forma aislada, sino que suelen ser parte de una cirugía multinivel de VAS o como complemento a un avance maxilomandibular.…”