Key Points of Surgery and Current Status in Japan on Hypoglossal Nerve Electrical Stimulation

Abstract

I explain the key points of DISE and surgery regarding hypoglossal nerve electrical stimulation therapy. DISE should not be performed with excessive sedation, and oxygen should be avoided as much as possible. For surgery, the first step in the cervical region is to identify the digastric muscle. The key to smooth identification is to identify the anterior border of the submandibular gland. The key points in the main trunk of the hypoglossal nerve are the determination on the presence or absence of Type 2 (HG late) and separation of the HG late from the main trunk of the hypoglossal nerve. In the thoracic region, if the fatty layer under the pectoralis major muscle is found, never perform rough manipulation, and if the muscular layers of the external and internal intercostal muscles are not found, probe more medially. As of June 2024, there have been only 38 cases of this HNS surgery in Japan. This is despite the fact that there are 100,000 to 150,000 patients in Japan who are intolerant to or unable to tolerate CPAP. This surgery offers the fulfillment surgical techniques that cannot be experienced in other otorhinolaryngological surgeries, such as intra-nerve manipulation and intra-thoracic surgery. I eagerly hope that many otorhinolaryngologists will participate in treatment that includes this surgery.