Adjustable Minimally Invasive Hyoid Myotomy and Suspension with Uvulopalatopharyngoplasty for the Treatment of Obstructive Sleep Apnea

Abstract

Objectives:

Examine the efficacy of minimally invasive hyoid myotomy and mandibular suspension with adjustable tensioning for hypopharyngeal obstruction in conjunction with uvulopalatopharyngoplasty in the surgical treatment of obstructive sleep apnea.

Methods:

Retrospective chart review in a private practice. Twenty consecutive patients with multilevel obstructive sleep apnea over a 12-month period were included. Patients underwent hyoid myotomy and suspension and uvulopalatopharyngoplasty with or without tonsillectomy either staged or performed at the same time for those patients who had not undergone uvulopalatopharyngoplasty previously. The hyoid was suspended to the posterior surface of the mandible using the Siesta Encore system and desired tension set through a single small submental incision. Patients underwent clinical examination and sleep study prior to surgery and approximately 3 months postoperatively. The primary outcome was a successful surgical result, defined as respiratory distress index lower than 20, and 50% or greater decline in respiratory distress index, and no oxygen desaturations below 85% on the postoperative sleep study.

Results:

Nineteen (95%) of 20 patients achieved a successful outcome. The average preoperative respiratory disturbance index (RDI) was 52.7. The average postoperative RDI was 11.8 (P < .005). The average preoperative body mass index was 27.3. The average decrease in the RDI was 78%. All patients in the study reported clinical improvement of symptoms. There were 2 minor wound complications and no major complications.

Conclusions:

For patients with multilevel obstructive sleep apnea, minimally-invasive mandibular hyoid suspension appears to be highly efficacious for the treatment of hypopharyngeal airway obstruction when performed in conjunction with uvulopalatopharyngoplasty.