[Problems of hyomandibulopexia in patients with OSAS]

In cases of obstructive sleep apnea syndrome (OSAS) with intolerance of n-CPAP (nasal continuous positive airway pressure) treatment, hyoidthyroidpexia (synonym: hyoid suspension) has recently been advocated by some authors as a valuable surgical option. Despite a basically positive assessment, there is a risk of hindrance to the speaking and swallowing function. Moreover, the thyroid cartilage seems to be too weak for fixation of the hyoid with its complex muscular attachments. This reduces the likelihood of achieving positive long-term results. Considering aspects of preserving laryngeal function, we are reporting on 7 patients submitted to a hyomandibulopexia. This intervention counteracts the tendency of the tongue base to collapse by ventrolateral traction on the hypoglossal muscle via the severed greater horn of the hyoid. We have thus far had to correct our surgical procedure three times because of methodological problems in the postoperative phase. Specific problems with surgical materials like steel wire or Goretex are discussed. In conclusion, we explain why we consider a bone anchored Kevlar suture (FASTak of Arthrex) to be suitable for this operation. Considering functional aspects, our polysomnographic and phoniatric follow-up examinations point to a less traumatic surgical procedure with promising treatment results.