0588 Combination Therapy: Hypoglossal Nerve Stimulation and Oral Appliance Therapy

Abstract Introduction Hypoglossal nerve stimulation (HGNS) is an implantable body that protrudes the tongue anteriorly during sleep. This surgical procedure is effective with minimal side effects, however for some patients 80 complications arise and require additional treatment modalities. One such alternative is oral appliance therapy that uses a different mechanism of action to displace the mandible anteriorly which is worn on the upper and lower teeth. Methods Five patient charts were identified out of 80 that had undergone hypoglossal nerve stimulation surgery with subsequent placement of oral appliance. Patient characteristics were identified to understand clinical reasoning leading to combination therapy and success of treatment. Results The most common reasons for a referral to the dentist after surgical placement of hypoglossal nerve stimulator is due to abrasion of the tongue (60%) and residual snoring (60%) with some patients having multiple reasons for the referral. Oral appliances were made for 4 of the 5 patients. Of the 4 patients all have evidence of tooth wear with 50% of patients having minor chipping on a front tooth. Average pre-treatment AHI was 33±13 to average post-treatment for combination therapy (HGNS with oral appliance) AHI of 6±2. Combination treatment eliminated both residual snoring and abrasion of the tongue in all patients. Conclusion The limitations are that there was a small sample size since a referral after HGNS surgery to oral appliance is rare. While conclusions about the patient characteristics cannot be generalized to the general population due to the small sample size, it was found that all patients had evidence of tooth wear which is common in the obstructive sleep apnea population. Clinically, combination therapy of HGNS and oral appliance therapy can be a viable alternative for some patients. Support (if any) None.