Hypopharyngeal surgery opens the airways behind the nasal cavity and mouth to improve your breathing while you sleep. There are different causes for airway obstruction in the lower part of your throat. The most common are tongue size or problems with your tongue muscle that makes it collapse (fall back) into your throat.
Hypopharyngeal airway surgery is a type of sleep surgery for obstruction (blockage) in the lower throat that causes breathing problems, like obstructive sleep apnea.
Types of hypopharyngeal surgery include:
- Upper airway stimulation: electrical pulses activate muscle tone
- Genioglossus advancement: repositions the tongue at the point where it attaches to the lower jaw
- Tongue base ablation: shrinks and tightens the base of the tongue
- Hyoid and tongue base suspension: repositions the hyoid bone (anchor structure for the tongue) and tongue base
- Skeletal surgery: expands the jaws to open the entire airway
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 (suspends 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 as 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 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.
Why Choose UHealth?
Experienced pediatric and adult sleep surgeons. You can be confident your surgery is performed by board-certified pediatric or adult sleep medicine surgeons. Whatever the procedure, you receive the right care for the best outcomes.
Innovative minimally invasive hypopharyngeal procedures for sleep disorders. We always choose the least invasive techniques to effectively treat your condition — which means less pain and a quicker recovery. Our sleep surgeons also offer the most advanced techniques like upper airway stimulation for obstructive sleep apnea.
Combined surgeries to make life easier for you. We understand the various causes of sleep-disordered breathing problems and perform expert procedures at the same time whenever possible. Some hypopharyngeal procedures can be combined or performed with other techniques for obstruction higher in the airway system, such as nasal or palate surgery.
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