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Elective Cosmetic Neck Surgery in a Patient with a Hypoglossal Nerve Stimulation Device: A Case Report
Marjorie C. Kragel, M.D.
Pierce L. Janssen, M.D.
Elad Fraiman, B.A., M.P.H.
James E. Zins, M.D., F.A.C.S.
Cleveland Clinic
2025-01-10
Presenter: Marjorie C. Kragel, M.D.
Affidavit:
The concept for the paper was a joint effort among all authors. Dr. Kragel has been responsible for constructing the manuscript and abstract, as well as leading the project. Dr. Janssen provided critical insight and assistance with revisions. Elad Fraiman assisted with manuscript drafting. The senior author Dr. Zins oversaw all stages of the project, assisted with revisions, and provided critical guidance.
Director Name: James E. Zins, M.D., F.A.C.S.
Author Category: Other Specialty Resident
Presentation Category: Clinical
Abstract Category: Aesthetics
Introduction:
The use of Inspire hypoglossal nerve stimulators (HNS) for managing obstructive sleep apnea (OSA) is increasing, yet limited guidance exists on the safe approach to neck rejuvenation surgery in patients with these implants. Understanding the anatomy and potential risks of operating on patients with Inspire devices is critical for plastic surgeons. This report discusses the execution of neck rejuvenation in a patient with an Inspire device and offers recommendations for managing such cases.
Case Presentation:
A 64-year-old male with excess neck skin and tissue laxity sought surgical rejuvenation. He had a history of severe OSA treated with an Inspire HNS placed three years prior. After thorough preoperative counseling, he underwent direct excision of neck skin with Z-plasty. Intraoperative ultrasound mapping confirmed that the Inspire lead was positioned lateral to the planned dissection field. Postoperatively, the patient reported difficulty activating the device, but diagnostic evaluation confirmed normal function. He did require a temporary reduction in stimulation amplitude, possibly related to intraoperative bipolar cautery use. The patient was successfully titrated back to his original settings and ultimately achieved an excellent cosmetic result.
Discussion:
This case highlights strategies to minimize risks when performing neck rejuvenation in patients with Inspire devices. Understanding the components of the Inspire device and their relationship to anatomic structures is critical. Ultrasound can identify lead placement and guide safe dissection. Bipolar cautery or ultrasonic scalpel should replace monopolar cautery when possible. Preoperative counseling and close postoperative follow-up with sleep specialists are essential for optimal outcomes.
