1318 Hypoglossal Nerve Stimulation Lead with Recurrent Extrusion

Abstract Introduction Hypoglossal nerve stimulation (HNS) is increasingly being utilized for treatment of obstructive sleep apnea (OSA) in patients with intolerance to positive airway pressure. One HNS device consists of an implanted pulse generator, a respiratory sensing lead, and stimulation lead. Lead migration, misalignment, and extrusion have been reported. We describe a case of recurrent stimulation lead extrusion. Report of case(s) A 54-year-old man with severe OSA (apnea-hypopnea index 44.6/hour), shift work disorder, and hypertension underwent HNS implantation in March 2024. He had an uncomplicated post-operative course and HNS activation. He followed up with sleep medicine and was given instructions for continued amplitude adjustments. He did not follow up as scheduled, instead re-presenting in March 2025 for evaluation of progressive neck fullness to otolaryngology clinic. On physical examination, it was found that the stimulation lead was extruding 2-3 cm out of his neck without signs of infection. The following day, he had surgical revision, including freeing the lead wire and tucking it under the submandibular gland, suturing the gland over the wire, creating a sterno-hyoid flap and suturing that over the gland and wire, closing of the platysma over the strap muscle flap, and closing the skin in multiple layers. Intraoperative testing indicated normal function. The patient presented for follow-up to sleep medicine six months post-revision with concerns of wire extruding out his neck again. Exam revealed a visible wire at his neck incision under a thin layer of skin without signs of infection. HNS was functioning, but review of data showed continued sporadic usage from the first day post-revision with titration just below his upper limit at 1.9V. He was referred back to otolaryngology for recurrent lead extrusion, and the device was subsequently explanted in October 2025. Conclusion HNS lead extrusion has been reported to be a rare complication. The reason for the recurrent lead extrusion was not known in this case but did not appear to be related to an infection. Management with lead revision, lead replacement, or HNS removal does not have robust data. However, if lead revision or replacement is chosen for management, the patient should be informed that recurrence is possible. Support (if any)