Modified hyoid suspension for therapy of sleep related breathing disorders. Operative technique and complications.

Background: Concerning the therapy of obstructive sleep apnea (OSA) the dis crimination between either retropalatal or retrolingual site of obstruction seems to be an oversimplification. Thus modern surgical concepts address b oth anatomical areas. Minimal invasive surgical techniques treating the sof t palate have recently been developed while there is still an ongoing devel opment concerning the base of tongue. Methods: A less invasive modification of the hyoid suspension to the thyroid cartilage, originally described by Riley, is presented as treatment modality for sleep related breathing disor ders. Between October 2000 and March 2001,14 patients underwent modified hy oid suspension within a multi-level surgery concept. The operative techniqu e manages with only one wire-suture and does not include myotomies and inte rsection of the ligamenta stylohyoidea. Results: All together 10 male and 4 female subjects with a mean age of 50.9 years were included in the analysi s. Preoperatively the mean apnea hypopnea index (AHI) was 18.4. The procedu re was well tolerated. Neither increased postoperative pain nor increased r equirement of analgetics was observed. Substantial side-effects were one ca se of seroma and 9 cases of transitory dysphagia. The retrolingual airway s pace increased significantly after surgery. Conclusions: These preliminary results are promising. The presented modified hyoid suspension is time-effe ctive and shows less postoperative morbidity. Therefore it might become a s uitable treatment modality within the multi-level surgery concept for sleep related breathing disorders.