Hyoid Suspension With UPPP for the Treatment of Obstructive Sleep Apnea.

This retrospective evaluation of surgical outcomes for hyomandibular suspension when performed with uvulopalatopharyngoplasty (UPPP) for the treatment of obstructive sleep apnea (OSA). Thirty-nine patients with moderate-to-severe OSA were treated with hyoid myotomy and suspension and uvulopalatopharyngoplasty. Patients underwent hyoid advancement and suspension to the mandible (Encore System) with either staged or concurrent UPPP. The primary outcome was a successful surgical result, defined as an apnea hypopnea index (AHI) lower than 20, and a 50% or greater decline in AHI on postoperative polysomnography. Successful surgical results were achieved in 30 (76.9%) out of 39 patients. The mean preoperative AHI improved 69.2% from 49.9 ± 25.6 to 15.4 ± 14.9 (P < .001) postoperatively. All patients reported clinical improvement of symptoms. There were 4 wound complications and one infection requiring removal of hardware. For patients with multilevel obstructive sleep apnea, hyoid advancement and suspension to the mandible appears efficacious when performed in conjunction with uvulopalatopharyngoplasty.

Hyoid myotomy and suspension without simultaneous palate or tongue base surgery for obstructive sleep apnea.

OBJECTIVE: Determine the effects of hyoid myotomy and suspension (HMS) without concurrent palatal or tongue base sleep surgery for obstructive sleep apnea (OSA). METHOD: Patients with OSA treated with HMS were identified using CPT code (21685) at an academic and private sleep surgery clinic. Those who underwent concurrent palatal or tongue base sleep surgery were excluded. Outcomes included simultaneous procedures, apnea-hypopnea index (AHI), lowest oxyhemoglobin saturation (LSAT), and Epworth Sleepiness Scale (ESS). RESULTS: Nineteen patients with OSA underwent HMS without palatal or tongue base sleep surgery. The average age at surgery was (55.3 ± 13.5) years with a majority of patients being male (71%). Concurrent procedures included the following: torus mandibularis excision (n = 1), endoscopic sinus surgery (n = 4), septoplasty (n = 10), inferior turbinate reduction (n = 12), and nasal valve repair (n = 2). AHI improved significantly from (39.7 ± 21.2) events/h to (22.6 ± 22.7) events/h after HMS (P < 0.01), which represented a 43% reduction. LSAT significantly increased from (82.2% ± 9.9%) to (86.6% ± 6.2%), P < 0.01. There was no improvement in ESS after surgery (8.2 ± 4.4) to (8.3 ± 5.2), P = 0.904. A subset of patients with severe OSA (AHI > 30 events/h) had an improvement in AHI from (49.9 ± 16.6) events/h to (29.1 ± 24.9) events/h, P < 0.01. CONCLUSION: HMS without palatal or tongue base sleep surgery improves OSA severity. It can be considered as a valid option in the treatment of OSA in appropriately-selected patients.