Hyoid myotomy with suspension under local anesthesia for obstructive sleep apnea syndrome

Abstract

Upper airway obstruction of patients with obstructive sleep apnea syndrome (OSAS) occurring during sleep can appear at multiple sites. Successful results of hyoid myotomy with suspension (HM) in the treatment of hypopharyngeal obstruction performed under general anesthesia have been reported. However, many OSAS patients have difficulty at the induction of anesthesia and intubation. They are predisposed to specific complications owing to anatomical abnormalities of the airway and the existence of an underlying syndrome. The purpose of this study was to assess the safety and efficacy of HM for the treatment of OSAS under local anesthesia. Thirty-two OSAS patients with hypopharyngeal obstruction underwent HM under local anesthesia. The hyoid bone was suspended to the superior aspect of the thyroid cartilage. Uvulopalatal flap was an adjunct surgical procedure for palatal obstruction. Patients had a mean age of 39.2±5.7 years and a body mass index of 29.3±2.4 kg/m 2 . Data on the patients were compared from preoperative to postoperative assessment points. Statistical analysis was performed using the Student's t-test. All patients tolerated the procedure well. The mean follow-up was 8.1±2.4 months (range 5 to 10 months). The mean RDI decreased from 44.5±8.7 to 15.2±5.6 (P <0.001), and the lowest oxygen saturation increased from 82.1±3.7% to 87.9±2.7% (P <0.01). The Epworth sleepiness scale improved from 14.1±2.2 to 8.2±2.3 (P <0.01), and the snoring scale improved from 8.5±1.8 to 3.5±1.7 (P <0.001). Postoperative complications included transient dysphagia in 3% of the patients and transient aspiration in 9%. Bleeding, infection and airway obstruction were not observed. Most patients had mild to moderate pain (visual analog scale ≤7) for 5 to 7 days after the procedures. Responders were defined as OSAS patients who had a reduction in the respiratory disturbance index (RDI) of 50% or more and a RDI of 20 or less after surgery. By these criteria, 78% of the patients were regarded as having responded to HM. A significant reduction in the RDI and clinical improvements were observed after HM. It appears to be a safe, inexpensive and effective procedure that can be performed under local anesthesia with a low probability of complications.

Outcomes of Hyoid Suspension for the Treatment of Obstructive Sleep Apnea

“…This is the second study that has evaluated hyoid suspension alone without previous or concurrent genioglossus advancement in patients with OSA. Our results are substantially worse than those of Neruntarat, 12 who reported successful outcomes in 78%. The criteria for successful outcome in both studies were similar, the only difference being our addition of a threshold for postop-erative LSAT.…”

“…A major concern is the high percentage of patients in the present study, especially those with mild disease preoperatively, who had a significantly worse RDI following surgery. Neruntarat 12 did not report how many patients experienced a worsened RDI, but it was apparently far fewer than in the present study.…”

Hypopharyngeal Surgery in Obstructive Sleep Apnea

“…The patient populations are distinguished by their preoperative characteristics. Compared with the other 2 studies, the sample presented by Bowden et al 30 had a higher preoperative BMI and LSAT (82.1% vs 72.7% in the study by Neruntarat 28 and not reported in the other 2 studies). In turn, the postoperative results differ markedly in the raw improvements in AHI, as well as the proportion that achieved a successful outcome according to a sleep study; the population with the highest BMI and higher LSAT had the worst out-comes.…”

“…The technique was later revised to secure the hyoid arch anteriorly to the superior border of the thyroid cartilage. 5 Four studies [27][28][29][30] have considered the role of hyoid suspension as the sole procedure to treat hypopharyngeal airway obstruction ( Table 4). The revised technique of hyoid suspension to the thyroid cartilage was used in all 4 series, and all patients had palate surgery performed previously or in the same setting.…”

Stellenwert der Nicht-nCPAP-Verfahren in der Therapie des obstruktiven Schlafapnoe-Syndroms. Relevance of Non-CPAP Treatment Options in the Therapy of the Obstructive Sleep Apnoea Syndrome

“…[191]. Operiert wird in der Regel in Vollnarkose, obwohl die Hyoidsuspension als isolierter Eingriff auch in Lokalanästhesie durchgeführt werden kann [80,82,152]. Literatur…”