Hyoid expansion with titanium plate and screws with hyomandibular suspension: A study on human cadavers with computed tomographic comparative analysis. Issue 6 (21st October 2020)

• Record Type: Journal Article
• Authors: Ng, Adele Chin Wei; Salkade, Parag Ratnakar; Rangabashyam, Mahalakshmi; Loh, Shaun Ray Han; Toh, Song Tar
• Is Part Of: Laryngoscope investigative otolaryngology. Volume 5:Issue 6(2020)
• Page Start: 1240
• Page End: 1246
• Publication Date: 2020-10-21
• Subjects: computed tomography -- hyoid expansion -- hyomandibular suspension -- obstructive sleep apnoea; Otolaryngology -- Periodicals; Laryngoscopy -- Periodicals; Otolaryngology; Otolaryngology; Periodicals; Periodicals; 617.51
• DOI: 10.1002/lio2.476
• Languages: English
• ISSNs: 2378-8038

Abstract

Abstract: Objective(s): Obstructive sleep apnoea is characterized by repetitive obstruction of the upper airway during sleep. These repeated oxygen desaturations increase cardiovascular and cerebrovascular morbidity and mortality significantly. Upper airway surgery is an option for patients who fail continuous positive airway pressure therapy. Airway collapse is usually multilevel and hypopharyngeal collapse is a challenging area to address. It is hypothesized that hyoid expansion with hyomandibular suspension can potentially increase upper airway dimensions at the hypopharynx. This study aims to document the effect of hyoid expansion using titanium plate and screws with hyomandibular suspension on hypopharyngeal airway dimensions. It is an anatomical feasibility study performed using 10 human cadaver heads. Methods: The hyoid bone is trifractured. The expanded hyoid is then suspended to the mandible. Computed tomography (CT) scans were performed on the cadavers to measure the airway dimensions before and after the procedure. Results: This procedure resulted in statistically significant increase in airway dimensions at the level of the hypopharynx in all 10 human cadaver heads. Increase in cross‐sectional area correlated significantly with increase in 3‐dimentional (3D) volume. The mean area of the airway at the level of the hyoid increased from 999.3 ± 193.0 mm 2 to 1241.4 ± 103.2 mm 2 . Statistically significant increase in upper airway volume based on 3D reconstruction was also noted. Upper airway volume increased from 6.94 ± 6.46 mL to 13.58 ± 8.29 mL. Conclusion: Airway dimensions increased with hyoid expansion and hyomandibular suspension in our cadaveric study measured using CT scans. Further studies are needed to see if this technique can be translated to clinical use in live patients. Level of evidence: NA. Abstract : Obstructive sleep apnoea is characterized by repetitive obstruction of the upper airway during sleep. Airway collapse is usually multilevel and hypopharyngeal collapse is a challenging area to address. It is hypothesized that hyoid expansion with hyomandibular suspension can potentially increase upper airway dimensions at the hypopharynx. This study aims to document the effect of hyoid expansion using titanium plate and screws with hyomandibular suspension on hypopharyngeal airway dimensions using human cadaver heads.