Surgery for hypopharyngeal obstruction causing OSA
Reviewed by Suzanne Jervis

Surgical treatments for OSA are evolving with improved diagnostic accuracy of the level(s) involved. Where the collapsing segment lies below the soft palate, a variety of surgical techniques to correct the affected segment(s) are emerging. This article concentrates on one such procedure – the hyoid suspension, a procedure which originated from a patient with continued symptoms following UPPP, who subsequently underwent inferior sagittal mandibular osteotomy combined with hyoid myotomy and suspension. The technique that the article describes is a revision of the original, but instead of the hyoid being suspended superiorly, it is divided from the infrahyoid muscles and attached inferiorly to the thyroid cartilage with non-absorbable sutures. The technique is described adequately with accompanying line drawings. However, determining the effectiveness of this technique appears elusive. The reviewed literature includes a number of studies where the hyoid suspension procedure is performed as part of a ‘package’ of multilevel surgery. In addition, defining the outcomes for surgical success varies considerably across the studies (e.g. BMI, AHI and patient subjectivity) such that adequate comparisons are compromised. Where they have tried to isolate the procedure, ‘surgical success’ appears to be in the region of 45% and 52% and in 39 patients, six developed an infection, abscess or fistula (15%). It is likely that given the limited success and risk profile regarding fistula in particular, it may be a procedure to consider as a last option prior to tracheostomy in patients with severe OSA, rather than their first.

Hyoid suspension: hyothyroid and hyomandibular options.
Benoist LBL, van Maanen JP, de Vries N.
OPERATIVE TECHNIQUES IN OTOLARYNGOLOGY – HEAD AND NECK SURGERY
2015:26(4);178-82.