Hyoid suspension as the only procedure

Hyoid suspension is a procedure to stabilise the retrolingual space in obstructive sleep apnoea. Using the Hörmann technique, a steel wire is slung around the body of the hyoid and fixed to the upper rim of the thyroid cartilage. It was observed, however, that the steel wire may lie very superficially to the pharyngeal mucosa. Evaluation of computed tomography (CT) scans showed a mean distance between the hyoid and the pharynx of only 3 mm. A modification is presented by threading a steel wire through a hole that is drilled through the hyoid bone. Thus pharyngeal exposure of the steel ligature and possible perforation of the mucosa is avoided.

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Modified Hyoid Suspension in the Treatment of Obstructive Sleep Apnea

Otolaryngology ◽

10.1177/0194599811415823a455 ◽

2011 ◽

Vol 145 (2_suppl) ◽

pp. P273-P273

Author(s):

Ottavio Piccin ◽

Francesca Marra ◽

Giovanni Sorrenti ◽

Giuseppe Scaramuzzino ◽

Ricardo Gobbi

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Obstructive Sleep ◽

Hyoid Suspension

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Uvulopalatopharyngoplasty and barbed reposition pharyngoplasty with and without hyoid suspension for obstructive sleep apnea hypopnea syndrome: A comparison of long-term functional results

Bosnian Journal of Basic Medical Sciences ◽

10.17305/bjbms.2020.4724 ◽

2020 ◽

Author(s):

Antonio Minni ◽

Fabrizio Cialente ◽

Massimo Ralli ◽

Andrea Colizza ◽

Quirino Lai ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Protective Factor ◽

Surgical Techniques ◽

Functional Results ◽

Apnea Hypopnea Index ◽

Obstructive Sleep ◽

Hyoid Suspension ◽

Hypopnea Syndrome

Obstructive sleep apnea hypopnea syndrome (OSAHS) is a common condition; when conservative approaches are not effective, surgical techniques aimed at reducing the airway obstruction effect are used. This retrospective study aimed at comparing the functional outcomes in patients with OSAHS undergoing uvulopalatopharyngoplasty (UPPP) according to Fairbanks and barbed reposition pharyngoplasty (BRP) according to Mantovani, with or without hyoid suspension (HS). One-hundred twenty-two consecutive OSAHS patients who underwent surgical treatment were included in the study. Patients were divided into 4 groups; all patients underwent preoperative and postoperative polysomnography (PSG) with apnea/hypopnea index (AHI) and oxygen desaturation index (ODI) evaluation, and Epworth Sleepiness Scale (ESS) evaluation. The results were analyzed according to the different surgical procedures, in relation to the preoperative PSG and anthropometric data. A significant reduction was observed at 18-month follow-up for patients in BRP group for BMI (p = 0.004), ESS (p < 0.0001), ODI (p < 0.0001), and AHI (p < 0.0001). Risk factors for poor postoperative AHI reduction were evaluated; preoperative AHI was the strongest independent protective factor, while preoperative ODI was the strongest risk factor. The association of HS with UPPP or BRP showed significant results in terms of higher postoperative AHI reduction only when associated to UPPP (p < 0.0001). This study showed that the BRP technique was more effective compared to UPPP for patients with OSAHS. The association of HS showed greater benefits in UPPP compared to BRP. Randomized prospective trials with longer follow-up are necessary to confirm our results and formulate a more accurate indication of the optimal therapeutic strategy.

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Polysomnographic Outcomes Before and After Skeletal Surgeries for the Treatment of Obstructive Sleep Apnea

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2021.03.11906 ◽

2021 ◽

Vol 104 (3) ◽

pp. 445-452

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Apnea Hypopnea Index ◽

Success Rates ◽

Maxillomandibular Advancement ◽

Obstructive Sleep ◽

Before And After ◽

Hyoid Suspension ◽

Group 2 ◽

Osa Treatment

Objective: To evaluate polysomnographic (PSG) outcomes after common skeletal surgeries for the treatment of obstructive sleep apnea (OSA) in Thai patients. Materials and Methods: The retrospective study included OSA patients aged 18 years and older treated by hyoid suspension (HS) plus uvulopalatopharyngoplasty (UPPP) (Group 1), genioglossus advancement (GA) plus tongue base radiofrequency (TBRF) (Group 2), and maxillomandibular advancement (MMA) (Group 3) at Siriraj Hospital between January 2007 and October 2018. Those with incomplete PSG data were excluded. The primary outcome was the apnea-hypopnea index (AHI). Secondary outcomes were other PSG parameters and postoperative complications. Results: Twenty-four patients including 22 males and 2 females were included. Group1 (n=11), median AHI decreased from 45.4 to 24.1 events/hour (p=0.17), while lowest oxygen saturation (LSAT) changed from 72.0% to 71.0% (p=0.11). Group2 (n=3) median AHI decreased from 64.7 to 51.4 events/hour (p=0.11), LSAT increased from 76.0% to 79.0% (p=1.0), and rapid eye movement (REM) sleep increased from 0.0% to 12.4% (p=0.11). Group3 (n=12) median AHI decreased from 68.5 to 7.8 events/hour (p<0.002), LSAT increased from 75.5% to 88.0% (p=0.04), and REM increased from 0.0% to 21.5% (p=0.01). Surgical success rates as defined by Sher’s criteria or a postoperative AHI of less than five events/hour were 44.4%, 33.3%, and 66.6% in patients in groups 1, 2, and 3, respectively. Common surgical complications included bleeding, mental or perioral paresthesia, and malocclusion after MMA. Conclusion: The skeletal surgeries significantly improved some PSG parameters, and thus may be viable options for OSA treatment in Thai patients. Keywords: Obstructive sleep apnea, Skeletal surgery, Hyoid suspension, Genioglossus advancement, Maxillomandibular advancement, Thai

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