Tongue suspension: an evidence-based review and comparison to hypopharyngeal surgery for OSA

Laryngoscope. 2014 Jan;124(1):329-36. doi: 10.1002/lary.24187. Epub 2013 May 31.


Objectives/hypothesis: Our first objective was to perform a systematic review of suture-based tongue suspension procedures as a stand-alone therapy for hypopharyngeal obstruction in obstructive sleep apnea (OSA). A second objective compared outcomes of tongue suspension as part of a multilevel approach to OSA surgery to genioglossus advancement (GA) with uvulopalatopharyngoplasty (UPPP), and to genioglossus advancement with hyoid suspension (GAHM) with UPPP.

Study design: Systematic review.

Methods: The PubMed database was queried for English-language studies published after 1997 to create four cohorts: tongue suspension alone, tongue suspension with UPPP, GA + UPPP, and GAHM with UPPP. Chi-squared test was used to compare outcomes between cohorts.

Results: Twenty-seven studies were included, broken down into cohorts based on our selection criteria. Six studies qualified for the tongue suspension-alone group with a surgical success rate of 36.6%. Eight studies qualified for our cohort of tongue suspension with UPPP with a surgical success rate of 62.3%. Eighteen studies qualified for our remaining two cohorts: GA + UPPP, and GAHM + UPPP. Their surgical success rates were both 61.1%. A chi-squared test to compare surgical outcomes showed that there was no difference between tongue suspension with UPPP, GA + UPPP, and GAHM + UPPP.

Conclusion: Tongue suspension is effective and safe as part of a multilevel surgical approach for patients with OSA. As a stand-alone procedure, its success rate is 36.6%, comparable to UPPP procedures for OSA success rates across the board. Tongue suspension should be considered in patients with OSA who demonstrate tongue base obstruction.

Keywords: OSA; Tongue suspension; genioglossus advancement; hyoid suspension; hypopharyngeal; multilevel surgery.

Publication types

  • Comparative Study
  • Review
  • Systematic Review

MeSH terms

  • Humans
  • Hypopharynx / surgery*
  • Sleep Apnea, Obstructive / surgery
  • Sleep Apnea, Obstructive / therapy*
  • Sutures*
  • Tongue / surgery*