devices, which keep the lower jaw pushed forward during sleep, are
used to create more space for air to flow behind the tongue. Both
options are often effective in patients with mild to moderate OSA.
For patients who don't respond to those first-line treatment options,
surgery has traditionally involved resection or repositioning some por-
tion of the throat by tightening or removing muscles or resecting part
of the tongue base. With advanced minimally invasive techniques,
including robotic surgery, tissue cut or reshaped. Surgery is not an
ideal treatment option, however, because it changes the throat's nor-
mal form and function to create less airway obstruction during sleep.
Hypoglossal nerve stimulation therapy, also known as upper airway
stimulation or a "pacemaker for the tongue," is a new and possibly a
better way to prevent life-threatening apnea in patients with OSA,
says Michael Friedman, MD, an otolaryngologist–head and neck sur-
geon and medical director of Chicago (Ill.) ENT. Instead of removing
tissue and muscle to prevent airway blockage, surgeons implant a
small stimulator on the hypoglossal nerve, which controls motor func-
tion of the tongue. A sensor attached to the stimulator measures inspi-
ration and expiration to determine when stimulation of the nerve is
needed to keep the tongue from sliding against the back of the throat.
"Stimulating the hypoglossal nerve maintains tone in the palate and
tongue when the patient is asleep — it essentially keeps the tongue
awake," says Dr. Friedman. "That makes a lot of sense because it
keeps the throat open without cutting out healthy tissue or resecting
muscle."
N O V E M B E R 2 0 1 8 • O U T PA T I E N T S U R G E R Y. N E T • 1 0 1
Known as a pacemaker for the tongue,
hypoglossal nerve stimulation therapy is a new
way to prevent apnea in patients with OSA.
