Hyoid Surgery

How the Hyoid Bone Relates to Sleep Apnea

In sleep apnea patients, structural problems with the hyoid bone sometimes a cause of obstruction of the hypopharynx, a major level of the upper respiratory system, which causes irregular or problematic breathing patterns at night. The hyoid bone is a U-shaped bone located in a person’s neck, below the chin and above the thyroid (or Adams apple in male patients). It is attached to a muscle called the epidglottis that controls the opening of closing of the airway passage as a person breathes.

One of the purposes of the hyoid bone is to assist the body in movement of the tongue and upper throat during swallowing and early digestion. It controls bodily movement in that area and therefore can cause troubled breathing in instances when the hyoid bone is improperly structured or dysfunctional. It sometimes results in collapse of the tongue backward, intro the passageway of through the mouth.

Many patients with sleep apnea try to treat their symptoms with oral applicances such as tongue retaining devices or mandibular repositioning devices—or with CPAP (continuous positive airway pressure), which is the most accepted and widely practiced form of sleep apnea treatment. Nonetheless, treatment without surgical intervention is not always effective for some patients. When sleep apnea surgery is necessary, hyoid advancement has been known to be quite successful in reducing symptoms.

Hyoid Advancement as Sleep Apnea Surgery

During what’s called a hyoid suspension or hyoid advancement, a surgical device called a suture, consisting of what looks like a needle and thread, is used to move the hyoid bone closer to the front of the neck and face. Sometimes this is done by placing the string in the tongue and attaching it elsewhere, such as in the cartilage of the thyroid or the mandible (or jawbone) itself. Consequently, the back of the mouth and throat are opened up as to better channel air through the body, to and from the patient’s lungs.

Hyoid advancement is not usually ordered as a solo procedure for sleep apnea patients who need their airways opened up by surgery; sleep doctors often perform hyoid surgery and genioglossus surgery together because moving the hyoid bone forward has the effect of moving the tongue forward anyway. Tongue reduction surgery, UPPP surgery and nasal surgery are other options for surgical treatment of sleep apnea.  Like other procedures for sleep apnea surgery, hyoid surgery requires that a patient stay home from work for at least 1 week and may require hospitalization or a few days while the patient heals.  

Although the hyoid advancement procedure is generally a safe one, complications and after-effects do exist, including scarring of an incision that has to be made through the patient’s outer neck. Many patients simply feel discomfort with the idea of an external incision, as well. Other post-procedural complications of hyoid advancement also include blood collection, infection and difficulty swallowing. The success of the procedure and whether it cures sleep apnea completely is limited; the numbers vary from 20 or 70 percent of the results being positive. Talk to your doctor, surgeon or sleep expert if you are a sleep apnea patient who cannot cope with CPAP masks, CPAP machines and other bedside appliances meant to treat sleep apnea symptoms.  Ask a local sleep specialist a sleep question to learn more about hyoid surgery.