The three most common treatments for moderate to severe obstructive sleep apnea (OSA) are continuous positive airway pressure (CPAP), oral appliances, and surgery. Two possible surgeries are the hyoid suspension and tongue suspension. Moderate to severe OSA usually has at least some significant degree of obstruction at all three major levels of the upper airway: 1 – the nose and nasopharynx, 2 – the oropharynx, and 3 – the hypopharynx. Hyoid and tongue suspension only affect #3 – the hypopharynx.
The hyoid is a small C-shaped bone that lies in the neck just above the thyroid prominence of the thyroid cartilage (the Adams Apple). The hyoid is attached to the epiglottis (the trap door situated atop the airway) via the hyo-epiglottic ligament and the base of the tongue by the hyoglossus muscle.
In a hyoid suspension procedure, strong sutures are passed around the mid-portion of the hyoid bone and then attached to the back of the mandible (or sometimes the thyroid cartilage) and cinched into a more anterior location. In a tongue suspension, a strong suture is passed through the substance of the tongue muscle front to back, then passed from one side to the other in the back of the tongue just below the surface, and then back out to the front of the tongue in the front portion of the floor of mouth. The ends are then attached to the inner aspect of the mandible (chin bone). The base of tongue is then cinched forward to open the airway .