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For sleep apnea patients, one major reason why the uvulopalatopharyngoplasty (UPPP) procedure works only 40% of the time is because tongue collapse wasn't addressed. Once you add a tongue base procedure, success rates go up to about 80%. There are a number of options for tongue collapse, but one minimally invasive way of dealing with the problem is to literally tie the base of the tongue to the midline jaw, so that it doesn't fall back while you're sleeping. This procedure can be performed with basic operating room equipment, but a much more convenient way is to use a kit made by Influent, called Repose. It's an alternative, lesser invasive option to the standard mandibular osteotomy and genioglossus advancement (MOGA) procedure, where a rectangular window is cut in the lower midline jaw and pulled forward, which pulls the back of the tongue forward. Essentially, a small screw is placed behind the back, bottom midline part of the lower jaw and a permanent suture is attached. This permanent suture is passed through the back of the tongue, looped around, and brought back out in the area of the screw, and tied under gentle tension (see figures below). In effect, this suspends the tongue, so it doesn't fall back when you're on your back or in deep sleep due to muscle relaxation. This procedure can be done either though the mouth (under the tongue), or through the neck. In most cases, especially with men, an additional hyoid suspension procedure is needed, which has to be performed through the neck. Since you're already in the neck, it's much easier to place the suture through the neck, which results in faster healing and less tongue swelling. I first described this modification and recorded it on the instructional video that the company distributes to surgeons. Potential complications are uncommon, but weakness or numbness of the tongue is seen occasionally, which usually goes away after a few weeks to months (usually from bruising). Taste changes can occur in theory, but in my experience, I've yet to have anyone report this. If performed in conjunction with other procedures that address all the areas of obstruction, success rates can be up to 80%. The most common combination is the Repose procedure, along with a hyoid suspension, and a UPPP. If done by itself, patients can usually go home the next day, but if performed in combination with the hyoid and UPPP, you may need to stay in the hospital another 1-2 days, until you're able to swallow.
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