Hyoid Suspension With UPPP for the Treatment of Obstructive Sleep Apnea.

This retrospective evaluation of surgical outcomes for hyomandibular suspension when performed with uvulopalatopharyngoplasty (UPPP) for the treatment of obstructive sleep apnea (OSA). Thirty-nine patients with moderate-to-severe OSA were treated with hyoid myotomy and suspension and uvulopalatopharyngoplasty. Patients underwent hyoid advancement and suspension to the mandible (Encore System) with either staged or concurrent UPPP. The primary outcome was a successful surgical result, defined as an apnea hypopnea index (AHI) lower than 20, and a 50% or greater decline in AHI on postoperative polysomnography. Successful surgical results were achieved in 30 (76.9%) out of 39 patients. The mean preoperative AHI improved 69.2% from 49.9 ± 25.6 to 15.4 ± 14.9 (P < .001) postoperatively. All patients reported clinical improvement of symptoms. There were 4 wound complications and one infection requiring removal of hardware. For patients with multilevel obstructive sleep apnea, hyoid advancement and suspension to the mandible appears efficacious when performed in conjunction with uvulopalatopharyngoplasty.

STAT4 Phosphorylation of T-helper Cells predicts surgical outcomes in Refractory Chronic Rhinosinusitis.

Objective: Chronic rhinosinusitis (CRS) impacts an estimated 5% to 15% of people worldwide, incurring significant economic healthcare burden. There is a urgent need for the discovery of predictive biomarkers to improve treatment strategies and outcomes for CRS patients. Study design: Cohort study of CRS patients and healthy controls using blood samples. Setting: Out-patient clinics. Methods: Whole blood samples were collected for flow cytometric analysis. Mechanistic studies involved the transfection of human primary T cells and Jurkat cells. Results: Our analysis began with a 63-69 year-old female patient diagnosed with refractory CRS,. Despite undergoing multiple surgeries, she continually faced sinus infections. Whole exome sequencing pinpointed a heterozygous IL-12Rb1 mutation situated in the linker region adjacent to the cytokine binding domain. When subjected to IL-12 stimulation, the patient's CD4 T-cells exhibited diminished STAT4 phosphorylation. However, computer modeling or T-cell lines harboring the same IL-12 receptor mutation did not corroborate the hypothesis that IL-12Rb could be responsible for the reduced phosphorylation of STAT4 by IL-12 stimulation. Upon expanding our investigation to a broader CRS patient group using the pSTAT4 assay, we discerned a subset of refractory CRS patients with abnormally low STAT4 phosphorylation. The deficiency showed improvement both in-vitro and in-vivo after exposure to Latilactobacillus sakei (aka Lactobacillus sakei), an effect at least partially dependent on IL-12. Conclusion: In refractory CRS patients, an identified STAT4 defect correlates with poor clinical outcomes after sinus surgery, which can be therapeutically targeted by Latilactobacillus sakei treatment. Prospective double-blind placebo-controlled trials are needed to validate our findings.

Hyoid myotomy and suspension without simultaneous palate or tongue base surgery for obstructive sleep apnea.

OBJECTIVE: Determine the effects of hyoid myotomy and suspension (HMS) without concurrent palatal or tongue base sleep surgery for obstructive sleep apnea (OSA). METHOD: Patients with OSA treated with HMS were identified using CPT code (21685) at an academic and private sleep surgery clinic. Those who underwent concurrent palatal or tongue base sleep surgery were excluded. Outcomes included simultaneous procedures, apnea-hypopnea index (AHI), lowest oxyhemoglobin saturation (LSAT), and Epworth Sleepiness Scale (ESS). RESULTS: Nineteen patients with OSA underwent HMS without palatal or tongue base sleep surgery. The average age at surgery was (55.3 ± 13.5) years with a majority of patients being male (71%). Concurrent procedures included the following: torus mandibularis excision (n = 1), endoscopic sinus surgery (n = 4), septoplasty (n = 10), inferior turbinate reduction (n = 12), and nasal valve repair (n = 2). AHI improved significantly from (39.7 ± 21.2) events/h to (22.6 ± 22.7) events/h after HMS (P < 0.01), which represented a 43% reduction. LSAT significantly increased from (82.2% ± 9.9%) to (86.6% ± 6.2%), P < 0.01. There was no improvement in ESS after surgery (8.2 ± 4.4) to (8.3 ± 5.2), P = 0.904. A subset of patients with severe OSA (AHI > 30 events/h) had an improvement in AHI from (49.9 ± 16.6) events/h to (29.1 ± 24.9) events/h, P < 0.01. CONCLUSION: HMS without palatal or tongue base sleep surgery improves OSA severity. It can be considered as a valid option in the treatment of OSA in appropriately-selected patients.

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.