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October 2018

Cricopharyngeal Muscle Dysfunction Following Hypoglossal Nerve Stimulator Placement

Author Affiliations
  • 1Uniformed Services University of the Health Sciences, Bethesda, Maryland
  • 2Department of Otolaryngology Head and Neck Surgery, San Antonio Military Medical Center, San Antonio, Texas
JAMA Otolaryngol Head Neck Surg. 2018;144(10):948-949. doi:10.1001/jamaoto.2018.1700

Hypoglossal nerve stimulation (HGNS) is an alternative treatment to positive airway pressure (PAP) therapy for patients with moderate or severe obstructive sleep apnea (OSA) who cannot tolerate PAP.1 The implantable HGNS system is comprised of a stimulator lead, implantable pulse generator, and breathing sensor lead. The stimulator lead silicone cuff is placed around distal hypoglossal nerve branches, targeting innervation of intrinsic tongue musculature and the genioglossus (protrusor muscle), while excluding the styloglossus and hyoglossus (retractor muscles). Activation of these muscles stiffens and protrudes the tongue to open and stabilize the pharyngeal airway. It is considered favorable to include the first cervical spinal nerve (C1) branch to the geniohyoid muscle traveling with the hypoglossal nerve. Geniohyoid activation moves the hyoid and larynx anteriorly and superiorly, assisting in stabilizing the pharyngeal airway to relieve upper airway obstruction.2

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