Nerve monitoring–guided selective hypoglossal nerve stimulation in obstructive sleep apnea patients

Abstract

4. Laryngoscope, 126:2852-2858, 2016.

Outcome after one year of upper airway stimulation for obstructive sleep apnea in a multicenter German post‐market study

“…Standardized implant technique was implemented in both studies. Recent updates to the operative technique included a detailed approach for identifying tongue retractor muscles (mainly the styloglossus and hyoglossus muscles) using nerve integrity monitoring . All three centers in this study completed multiple implants before enrolling participants, which likely reduced issues associated with the surgical learning curve, as observed in the STAR trial …”

“…Over the last few years, surgical implantation techniques have been standardized and improved . Precise positioning of the stimulation electrode for activating tongue protrusors, but not retractors, has improved due to the use of nerve integrety monitoring . Surgeon experience has been shown to improve surgical time, safety, and outcome …”

Upper‐Airway Stimulation Before, After, or Without Uvulopalatopharyngoplasty: A Two‐Year Perspective

“…Breathing effort is detected by an intercostal sensor lead, which sends input to the infraclavicular implanted pulse generator, which then generates a smooth electric impulse via a stimulation cuff lead to the medial branches of the hypoglossal nerve that results in protrusion and stiffening of the tongue . There is a need for better understanding of the submental anatomy combined with intraoperative neuromonitoring, which can guide correct surgical placements to improve surgical outcomes, specifically through complete exclusion of retractor branches innervating styloglossus and hyoglossus muscles . The effectiveness and safety of UAS has been previously demonstrated in large cohorts and in long‐term follow‐up .…”

Predictive Success Factors in Selective Upper Airway Stimulation

“…This effect can best be achieved by stimulating the m-XII fibers supplying the genioglossus muscle and the transverse and vertical intrinsic muscles. To know intraoperatively which fibers are supplying which muscles, a nerve integrity monitoring system with a bipolar electrical stimulation probe is needed [48] . Two single-use color-coded 18-mm Prass paired electromyography electrodes are placed into the tongue 5 cm from the tip of the tongue just below the tongue's edge and superficially to the mucous membrane to target the exclusion muscles hyoglossus and styloglossus, which are the main tongue retractors.…”