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Who is a Candidate?

Hypopharyngeal airway surgery may be an option when other sleep medicine therapies haven’t worked, such as continuous positive airway pressure (CPAP), oral devices, or medicines. Candidates for hypopharyngeal airway surgery have sleep-disordered breathing caused by:

  • Tongue muscle weakness
  • Tongue base that’s too large
  • Muscle weakness in the airways in the lower throat
  • Inflammation, or swelling, in the structures in the lower throat
  • Misaligned jaw bones

What to Expect

  • Upper airway stimulation

    Upper airway stimulation (sometimes called Inspire® therapy) is an implanted remote-controlled system. The system senses breathing patterns and delivers small electric pulses to activate nerves and open the airways during sleep. It involves three small implants:

    • Electrode placed on the hypoglossal nerve to make the tongue muscles move
    • Sensing lead placed between the rib muscles to detect breathing
    • Neurostimulator placed in the right upper chest to send the electrical pulse

    The implant procedure takes about two hours and is performed as an outpatient surgery (no overnight hospital stay). It takes about two weeks to recover fully.

  • Genioglossus advancement surgery

    This surgery involves the genioglossus muscle — the largest muscle in the tongue that is attached to a boney structure that sticks out of the lower jaw. The surgeon moves (advances) the tongue forward to prevent it from collapsing and blocking the airway during sleep. Generally, the surgeon will:

    • Make an incision in the lower lip
    • Cut a small rectangular segment in the lower jaw bone
    • Move the bone segment forward, with the tongue muscle, about an inch
    • Secure the fragment with a tiny screw to keep it in place

    The procedure takes about 30 minutes, and you will stay overnight at the hospital. Recovery can take 10 to 14 days.

  • Tongue base ablation

    Also referred to as radiofrequency ablation (RFA) for the tongue base, this minimally invasive procedure creates more room in the lower throat for airflow. It delivers targeted energy to scar the base of the tongue, causing it to shrink and tighten during healing.

    The procedure takes about 30 minutes in an outpatient office setting. Recovery takes a few hours and you should see results within one week.

  • Hyoid and tongue base suspension

    Tongue and hyoid suspension repositions the tongue base and the hyoid bone (a small horseshoe-shaped bone that supports muscles in the back of the throat) to expand and stabilize the airway. It combines two procedures: genioglossus advancement (repositions the tongue at the point where it attaches to the lower jaw) and hyoid advancement (suspending the hyoid bone to the front of the jaw bone with a sling-like stitch).

    Tongue and hyoid suspension surgery is often performed with other sleep surgeries for obstruction higher in the upper airways, such the nose and mouth. The procedure requires an overnight hospital stay. Recovery usually takes a week, with a return to full activity within two weeks.

  • Skeletal surgery

    Skeletal surgery involves moving the upper jawbone (the maxilla) and the lower jawbone (the mandible) forward in a procedure called maxillomandibular advancement. This skeletal surgery corrects misalignment (incorrect position) and opens the entire airway system. Maxillomandibular advancement takes a few hours, requires two to three days in the hospital, and a four-week recovery period.