Hyoid Bone Suspension as a Part of Multilevel Surgery for Obstructive Sleep Apnea Syndrome
14 June 2017
03 September 2017
25 October 2017 (eFirst)
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 (O2) 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.
- 1 Piccin O, Scaramuzzino G, Martone C, Marra F, Gobbi R, Sorrenti G. Modified hyoid suspension technique in the treatment of multilevel related obstructive sleep apnea. Otolaryngol Head Neck Surg 2014; 150 (02) 321-324
- 2 Morris LG, Kleinberger A, Lee KC, Liberatore LA, Burschtin O. Rapid risk stratification for obstructive sleep apnea, based on snoring severity and body mass index. Otolaryngol Head Neck Surg 2008; 139 (05) 615-618
- 3 Riley RW, Powell NB, Guilleminault C. Inferior sagittal osteotomy of the mandible with hyoid myotomy-suspension: a new procedure for obstructive sleep apnea. Otolaryngol Head Neck Surg 1986; 94 (05) 589-593
- 4 Riley RW, Powell NB, Guilleminault C. Obstructive sleep apnea syndrome: a surgical protocol for dynamic upper airway reconstruction. J Oral Maxillofac Surg 1993; 51 (07) 742-747 , discussion 748–749
- 5 Hörmann K, Baisch A. The hyoid suspension. Laryngoscope 2004; 114 (09) 1677-1679
- 6 Tschopp KP. Modification of the Hörmann technique of hyoid suspension in obstructive sleep apnoea. J Laryngol Otol 2007; 121 (05) 491-493
- 7 El-Ahl MA, El-Anwar MW. Expansion pharyngoplasty by new simple suspension sutures without tonsillectomy. Otolaryngol Head Neck Surg 2016; 155 (06) 1065-1068
- 8 Benazzo M, Pagella F, Matti E. , et al. Hyoidthyroidpexia as a treatment in multilevel surgery for obstructive sleep apnea. Acta Otolaryngol 2008; 128 (06) 680-684
- 9 Sher AE, Schechtman KB, Piccirillo JF. The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. Sleep 1996; 19 (02) 156-177
- 10 Hessel NS, de Vries N. Results of uvulopalatopharyngoplasty after diagnostic workup with polysomnography and sleep endoscopy: a report of 136 snoring patients. Eur Arch Otorhinolaryngol 2003; 260 (02) 91-95
- 11 White DP. Sleep-related breathing disorder.2. Pathophysiology of obstructive sleep apnoea. Thorax 1995; 50 (07) 797-804
- 12 Silverstein K, Costello BJ, Giannakpoulos H, Hendler B. Genioglossus muscle attachments: an anatomic analysis and the implications for genioglossus advancement. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000; 90 (06) 686-688
- 13 Bowden MT, Kezirian EJ, Utley D, Goode RL. Outcomes of hyoid suspension for the treatment of obstructive sleep apnea. Arch Otolaryngol Head Neck Surg 2005; 131 (05) 440-445
- 14 Kezirian EJ, Goldberg AN. Hypopharyngeal surgery in obstructive sleep apnea: an evidence-based medicine review. Arch Otolaryngol Head Neck Surg 2006; 132 (02) 206-213
- 15 den Herder C, van Tinteren H, de Vries N. Hyoidthyroidpexia: a surgical treatment for sleep apnea syndrome. Laryngoscope 2005; 115 (04) 740-745
- 16 Lin HC, Friedman M, Chang HW, Gurpinar B. The efficacy of multilevel surgery of the upper airway in adults with obstructive sleep apnea/hypopnea syndrome. Laryngoscope 2008; 118 (05) 902-908
- 17 Askar SM, El-Anwar MW, Amer HS, Awad A. Single triangular suture: A modified technique for hyoid suspension as a treatment for obstructive sleep apnea: Our experience with 24 patients. Clin Otolaryngol 2017; [Epub ahead of print]
- 18 Neruntarat C. Hyoid myotomy with suspension under local anesthesia for obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol 2003; 260 (05) 286-290
- 19 Stuck BA, Neff W, Hörmann K. , et al. Anatomic changes after hyoid suspension for obstructive sleep apnea: an MRI study. Otolaryngol Head Neck Surg 2005; 133 (03) 397-402