What is the role of thyrohyoid suspension in the treatment of obstructive sleep apnea (OSA)?

Updated: Feb 25, 2021
  • Author: Charles E Morgan, DMD, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Friedman designed thyrohyoid suspension (see the images below) for patients with moderate to severe OSA without enlarged palatine tonsils or for patients with a short (< 40 mm) hyomental distance. This procedure involves making a horizontal incision in the midline of the neck and advancing the hyoid bone anteriorly and inferiorly to the thyroid cartilage.

Hyoid suspension for obstructive sleep apnea. The Hyoid suspension for obstructive sleep apnea. The hyoid is divided in the midline, and the loop suture is passed around the hyoid. The loop suture is suspended to the mandible, thereby suspending the tongue base anterosuperiorly. This enhances the posterior air space. A variation of this procedure is the hyoid advancement, whereby the hyoid is advanced, with several sutures (ie, 2-0 Ethibond) anteriorly and inferiorly over the thyroid lamina. Reprinted with permission from Elsevier [Krespi YP and Kacker A. Hyoid suspension for obstructive sleep apnea. Operative Techniques in Otolaryngology-Head and Neck Surgery. 2002;13(2):144-9].

In essence, this procedure draws the base of the tongue forward, making it less likely to fall back against the posterior pharyngeal wall during sleep. In addition, the hyoid bone may be repositioned anteriorly with transection of the infrahyoid muscles and suspension to the mandible.

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