The hyoid bone is a U-shaped bone in the neck located above the level of the thyroid cartilage (Adam’s apple) that has attachments to muscles of the tongue as well as other muscles and soft tissues around the throat. The hyoid bone is free to move around rather than firmly anchored in position, and this mobility may allow this area to collapse and cause airway blockage during sleep more easily. This procedure secures the hyoid bone to the thyroid cartilage and helps to stabilize this region of the airway.

This procedure is performed for patients with obstructive sleep apnea, and it is performed in the operating room under general anesthesia. A small (usually 7-8 cm or 3 inches) skin incision is made, ideally in a natural neck skin crease to camouflage the scar. Four stitches are placed around the hyoid bone and the upper portion of the thyroid cartilage to stabilize the hyoid bone. The skin incision is closed with stitches, and usually a small drain is placed for 1-2 days to allow any fluid to escape without being trapped underneath the skin.

The hyoid bone is pulled forward and secured to the Adam’s apple with four stitches

Side view of the head and neck, after the hyoid suspension procedure

RISKS

Bleeding
As with any procedure, there is a risk of bleeding. A drain is placed to allow any drainage or bleeding to escape from the wound, and usually the drainage is minor. A major factor in preventing serious bleeding is to avoid the use of aspirin, NSAIDs (such as ibuprofen, Advil®, Motrin®, naproxen, or Aleve®), vitamin supplements, or herbal medications for at least two weeks before and after surgery.

Infection
Infection is rare but can occur if there is bleeding or drainage that accumulates inside the wound. Patients typically have a drain placed and/or receive antibiotics at the time of surgery to reduce the chance of infection.

Trouble swallowing
The tongue region of the throat is critical to swallowing, and swelling that occurs after a tongue procedure can present some difficulty. This should not be a permanent problem, although it may be. Difficulty swallowing can occur after surgery due to a number of factors, including generalized swelling in the area, structural changes produced by the surgery, and nerve injury. The nerves responsible for tongue movement and the sense of touch in the throat (both are important for swallowing) are in the area where the surgery is performed, but measures are taken to minimize the risk to these nerves during this procedure.

Need for additional procedures
Hyoid suspension may not be effective in accomplishing the goals of surgery. Another procedure—either performed on the tongue region or on another area—may be necessary.

POSTOPERATIVE INSTRUCTIONS

Pain control
You should be prescribed narcotic pain medication after hyoid suspension. Take this medication as you need it for pain control, and try not to let the pain increase until it becomes intolerable before you take the medication. If you prefer to avoid narcotics, you should feel free to use acetaminophen (Tylenol®). Avoid aspirin, NSAIDs (such as ibuprofen, Advil®, Motrin®, naproxen, or Aleve®), vitamin supplements, or herbal medications for at least two weeks because they can increase your risk of bleeding after surgery. Your pain will be significant for at least the first three days following surgery, but if you had other procedures performed at the same time the pain may be more severe.

Diet
Due to a combination of pain and swelling that is to be expected, you will most likely have some trouble swallowing. This may be either a difficulty in getting food to go down your throat or having liquids “go down the wrong way” into your windpipe (trachea), with coughing as a result. During your recovery, be careful with eating and drinking. Depending on whether other procedures were performed at the same time as hyoid suspension, you may only be able to tolerate a liquid diet for the first few days after surgery. It is helpful to drink liquids other than water (such as juices or Gatorade® and, especially, milk shakes or Ensure®) to provide energy and protein during the recovery period. After this period of time, you should transition to soft solid foods such as eggs or yogurt. You should be able to tolerate a normal diet by 14 days following surgery.

Antibiotics
You may be prescribed an antibiotic to take for several days. This can be useful for preventing infection or decreasing swelling. Take the antibiotics as directed. If you develop a rash or diarrhea (possible risks of antibiotics and other medications), stop the antibiotics and contact your doctor immediately.

Minimize physical activity for four weeks
At a minimum, patients should walk at least three times a day starting the day after surgery. Walking and spending more time out of bed (walking or in a chair) rather than in bed are helpful because they reduce the risks of developing pneumonia or blood clots in the legs. However, patients should avoid strenuous activity because it typically raises heart rate and blood pressure. For this reason, it can increase swelling or cause bleeding to start.

Sleep with head elevated (at 45 degrees) for at least three days
Elevating your head during sleep decreases blood flow to the head and neck regions. Therefore, it decreases swelling and the associated pain. Elevating the head during sleep may also improve breathing patterns in other ways. Therefore, we recommend elevating your head during sleep at 45 degrees for at least three days following the procedure.

NOTIFY DR. KEZIRIAN IMMEDIATELY IF YOU HAVE ANY TROUBLE BREATHING OR IF ANY BLEEDING DEVELOPS!