Influence of natural hyoid bone position and surgical repositioning on upper airway patency: a computational finite element modeling study

The hyoid bone's inferior baseline position in obstructive sleep apnea (OSA) has led to surgical hyoid repositioning (SHR) treatment, yet outcomes vary widely. The influence of baseline hyoid position (BHP; phenotype) and SHR on upper airway (UA) function remains unclear. We aimed to investigate their impact on the UA using computational modeling. A validated finite element model of the rabbit UA was advanced and used to simulate changes in BHP and SHR, alone and in combination. The hyoid was displaced in cranial, caudal, anterior, anterior-cranial, and anterior-caudal directions from 1 to 4 mm. Model outcomes included UA collapsibility, measured using closing pressure (Pclose), cross-sectional area (CSA), and soft tissue mechanics (displacement, stress, and strain). Graded BHP increments increased Pclose for all directions and up to 29%-43% at 4 mm (relative to the original BHP). Anterior-based SHR decreased Pclose (approximately -115% at 4 mm) and increased ΔCSA (approximately +35% at 4 mm). Cranial SHR decreased ΔPclose (-29%), minimally affecting CSA. Caudal SHR increased ΔPclose (+27%) and decreased ΔCSA (-7%). Anterior-cranial and anterior-caudal SHR produced the highest stresses and strains. SHR effects on UA outcomes were dependent on BHP, with more caudal BHPs leading to less effective surgeries. In conclusion, BHP (phenotype) and SHR both alter UA outcomes, with effects dependent on hyoid displacement direction and magnitude. BHP influences the effectiveness of SHR in reducing UA collapsibility. These findings provide further insights into the hyoid's role in UA patency and suggest that considering the hyoid's baseline position and surgical repositioning direction/increment may help improve hyoid surgeries for OSA treatment.<b>NEW & NOTEWORTHY</b> Using computational modeling, this study directly shows that any shift from the healthy natural hyoid bone position increases upper airway collapsibility. Surgical hyoid repositioning alters upper airway outcomes in a direction- and magnitude-dependent manner, with its effects influenced by the natural hyoid position. Accounting for both the natural hyoid position and individually prescribed surgical repositioning may enhance upper airway stability and improve outcomes in obstructive sleep apnea (OSA) treatment.