Simultaneous Operations on the Thyroid Gland and Hyoid Suspension in Patients With Combined Thyroid Pathology and OSA

Last updated: March 27, 2023
Sponsor: State Budgetary Healthcare Institution, National Medical Surgical Center N.A. N.I. Pirogov, Ministry of Health of Russia
Overall Status: Active - Recruiting

Phase

N/A

Condition

Sleep Apnea Syndromes

Treatment

N/A

Clinical Study ID

NCT05033626
NMSC-02-21
  • Ages 30-60
  • Male

Study Summary

Simultaneous operations on the thyroid gland and hyoid suspension in patients with combined thyroid pathology and moderate to severe OSA.

Eligibility Criteria

Inclusion

Inclusion Criteria:

  • The patient understands the essence of all procedures planned in the framework of aninitiative clinical trial and voluntarily confirms his desire to participate bywritten informed consent;
  • Male or female patients with completed skeletal growth at the age of 30 to 60 years,inclusively, with thyroid pathology and moderate to severe OSAS according tocardiorespiratory monitoring with obstruction of the soft tissues of the upperrespiratory tract at the levels of the oropharyngeal and laryngopharynx, withoutradiography of the pathology of the paranasal sinuses;
  • Еhe patient is scheduled for thyroid gland surgery (thyroidectomy with / withoutlymphadenectomy, subtotal resection of the thyroid gland, hemithyroidectomy).

Exclusion

Exclusion Criteria:

  • Women during pregnancy, childbirth;
  • Women during breastfeeding;
  • Persons with mental disorders;
  • Persons detained, taken into custody, serving a sentence in the form of restriction offreedom, arrest, imprisonment or administrative arrest;
  • Chronic somatic diseases in the stage of decompensation. Conditions and concomitantpathology of other organs, which are a contraindication for general anesthesia andintubation;
  • Diseases and conditions associated with severe bleeding disorders (hemophilia, vonWillebrand disease, deficiency of one or more coagulation factors, etc.);
  • Infectious diseases in the acute stage.
  • Severe brain injuries, which entailed consequences in the form of focal epilepsy,encephalopathy, dementia;
  • Pathology of the paranasal sinuses according to X-ray data;
  • Pathologies that are relative contraindications for CPAP therapy (bullous lungdisease; pulmonary emphysema; a history of pneumothorax, pneumomediastinum,pneumocephalus, respiratory distress syndrome, external liquorrhea; previous surgicalinterventions on the brain, middle or inner ear, pituitary gland; recurrent sinusitis;recurrent eye infections; severe hypotension; severe dehydration; frequent nosebleeds;fractures of the bones of the face; condition after esophagectomy in history (risk ofdamage to the anastomosis due to increased pharyngeal / esophageal pressure);hemodynamic instability; a history of severe chronic heart failure; Decompensation ofmajor diseases; cardiomyopathy of any genesis; oncological diseases (except forpathology of the thyroid gland);
  • Pathologies that are absolute contraindications for CPAP therapy (unconsciousness ofthe patient; severe respiratory failure, which may require intubation and subsequentmechanical ventilation; cerebrospinal fluid fistula; collapse of the epiglottisaccording to sleep endoscopy);
  • refusal of the patient to carry out CPAP therapy.

Study Design

Total Participants: 10
Study Start date:
October 15, 2021
Estimated Completion Date:
May 01, 2024

Study Description

The ineffectiveness of conservative treatment of obstructive sleep apnea syndrome (OSAS) (CPAP-therapy) or its rejection leads to a surgical solution of the issue, the purpose of which is to eliminate obvious anatomical obstacles, to increase the lumen of the upper respiratory tract. Modern methods of multilevel surgical treatment of OSAS make it possible to achieve more than 80% success.

Most often, at the first stage of OSAS treatment, otorhinolaryngologists use rhinosurgical techniques such as septoplasty, lower submucosal vasotomy, partial conchotomy, removal of nasal polyps, including using endoscopic techniques. At the subsequent stages of multilevel treatment, depending on the level of obstruction and the severity of OSAS, uvulopalatoplasty or uvulopalatopharyngoplasty, partial resection of the tongue or lingual tonsil, suspension of the tongue root and sublingual system, various types of genioplasty and maxillary reduction are performed.

This approach allows expanding the airways in the oropharyngeal region and laryngopharynx, improving functional outcomes and quality of life in patients with OSAS.

At the same time, first of all, it is necessary to carefully assess the benefits and potential risks of surgical treatment, especially in patients with an unfavorable morbid background and from older age groups.

• The investigators will offer patients with concomitant thyroid pathology and moderate or severe OSAS to perform simultaneous operations from one access, where the hyoid bone to the thyroid cartilage will be sutured in the second stage. The stabilization of the hyoid bone and the muscular frame, as an integral complex of the laryngopharynx, increases the airway space and neutralizes obstruction. (1-3) Under endotracheal anesthesia, a horizontal skin incision up to 5 cm long is made at the level of the upper edge of the thyroid cartilage, the skin and subcutaneous fat are dissected. The sternohyoid and sternothyroid muscles are retracted. An audit of the thyroid gland is performed. Step by step, using the ultrasonic dissector, the sections of the gland necessary for resection are separated, ligated, and transected. The vessels of the upper and lower poles are separated with the preservation of blood supply to the right and left upper and lower parathyroid glands. Using a microsurgical technique, neurolysis of the recurrent laryngeal nerves is performed. The control of the integrity of the recurrent laryngeal nerves was performed using the neuromonitoring apparatus.

The hyoid bone is mobilized in the anterocaudal direction and is fixed to the thyroid cartilage with four permanent non-absorbable sutures. If sufficient mobilization does not occur during the operation, the tendon of the stylohyoid muscle is dissected. Surgical drainage is installed 24 hours after surgery.

Advantages:

  • access from one incision with combined pathology of the thyroid gland and OSAS which reduces the need for delayed operations;

  • decrease in apnea hypopnea index (AHI) to 50.7% and subjective daytime sleepiness according to foreign literature.

Connect with a study center

  • Pirogov National Medical and Surgical Center

    Moscow, 105203
    Russian Federation

    Active - Recruiting

Not the study for you?

Let us help you find the best match. Sign up as a volunteer and receive email notifications when clinical trials are posted in the medical category of interest to you.