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Outcomes of Hyoid Myotomy and Suspension Using a Mandibular Screw Suspension System

Objective. To review the outcomes of hyoid myotomy and suspension with a mandibular screw anchoring device. Study Design. Case series with chart review. Setting. Academic and private sleep surgery clinics. Methods. The study is a consecutive case series of patients undergoing hyoid myotomy and suspension using a mandibular screw suspension device as part of multilevel treatment of obstructive sleep apnea (OSA). Outcomes of interest included complication rates, change in daytime sleepiness scores, and change in apnea-hypopnea index (AHI). Results. Ten women and 23 men with a mean age of 54 years (range, 33-73 years) underwent hyoid myotomy and suspension using a mandibular screw suspension device. Four (12%) patients experienced minor complications, including neck seroma (3 patients) and tongue edema (1 patient). Epworth Sleepiness Scale scores fell from a preoperative median of 12 to a postoperative median of 6 (P = .002). Ten patients (30%) refused the postoperative sleep study. In the 23 patients who underwent postoperative sleep studies, AHI scores decreased from a preoperative mean ± SD of 40.9 ± 25.1 to 18.6 ± 21.2 postoperatively (P = .001). Ten patients (30%) achieved a postoperative AHI below 10. The Repose system was initially applied using a standard hyoid dissection but was later modified using a minimally invasive small incision (<2 cm) approach that demonstrated significantly fewer complications (P = .04). Conclusion. Hyoid myotomy and suspension with a mandibular screw anchor is an effective method with which to address hypopharyngeal collapse in multilevel surgery for OSA. The procedure can be performed with a small-incision, minimally invasive approach with minimal complications and patient morbidity.