Extruded Hardware Lead in Hypoglossal Nerve Stimulation Device Successfully Reimplanted Without Explantation

by Linda Kossoff •

How was a case of extruded hardware following hypoglossal nerve stimulation surgery successfully managed with reimplantation without need for explantation and new device management?

BOTTOM LINE

In the absence of infection, lead wire exposure from hypoglossal nerve stimulation implantation can be treated with urgent surgery to reimplant the lead and salvage the device.

BACKGROUND: Hypoglossal nerve stimulation therapy is increasingly utilized to treat patients with obstructive sleep apnea (OSA) who are intolerant to continuous positive airway pressure (CPAP). The device used is composed of a lead that stimulates the hypoglossal nerve. A rare complication of this treatment is implant exposure or infection.

STUDY DESIGN: Case study.

SETTING: Department of Otorhinolaryngology–Head and Neck Surgery, Rush University Medical Center, Chicago, Ill.

SYNOPSIS: Researchers studied the case of a hypertensive, 48-year-old White male with chronic obstructive pulmonary disease, severe OSA, and CPAP noncompliance who received implantation of a right-sided hypoglossal nerve stimulation device. On postoperative day 45, a 1-cm loop of stimulation lead wire was noted to extrude from the wound. Imaging confirmed the exposure of wire without evidence of active infection. A second operation was performed in which the wound and hardware were irrigated and cleansed, and a fresh subplatysmal flap was elevated inferiorly and the wire loop reimplanted with closure over the device. The patient was treated postoperatively with oral clindamycin without signs of infection. At six months post-reimplantation, the wound had healed well, with no sign of extrusion or device malfunction following activation. Authors note the absence of published reports of extruded hypoglossal nerve stimulator lead wires. Past studies have proposed that, absent infection and in presence of stable hardware, salvage can be considered.

CITATION: Grond SE, Urban MJ, Hutz MJ, et al. Successful reimplantation of extruded lead after hypoglossal nerve stimulation surgery. Laryngoscope. 2023;133:2821–2822.