What is the hypoglossal nerve implant? 

The hypoglossal nerve implant is a treatment for sleep apnea. The device is surgically placed in your child’s chest and monitors their breathing at night. It also has an attached cuff that goes around a nerve in the upper neck under your child’s tongue. This cuff stimulates your child’s tongue to move forward, allowing the airway to remain open while they are sleeping.  

The nerve implant device is turned on and off with a remote. You will turn the device on when your child falls asleep at night and turn it off in the morning when they wake up.  

Your child may be eligible for the hypoglossal nerve implant if they have been diagnosed with Down syndrome (Trisomy 21) and are between 13 to 18 years old. The device was designed to treat moderate to severe obstructive sleep apnea for those who are unable to tolerate a traditional continuous positive airway pressure (CPAP) machine. It has also been FDA-approved for young adults over 18 years old. 

Hypoglossal nerve implant surgery  

Hypoglossal nerve implant surgery at Children’s Hospital of Philadelphia (CHOP) usually requires your child to stay overnight. They can go home the following day. During the procedure, your child will be under general anesthesia. Rest assured they will be completely asleep and unaware. They will not feel any pain.  

While your child is asleep, your CHOP surgeon will make two small cuts (incisions). The first will be on the right side of your child’s neck, just under the jawline. The second will be on the upper right portion of the chest where the implant will be placed. We will safely keep watch on your child’s tongue nerves during the procedure by placing small, sticky, plastic patches that connect to a monitoring device (electrodes) in their tongue muscles inside their mouth.  

After the procedure is finished, your child’s surgeon will place a special bandage (pressure dressing) on their chest to help promote healing. This dressing will be removed before your child leaves CHOP. The incisions will be closed with absorbable stitches (sutures) and surgical tape on top. The surgical tape will fall off on its own in the next few days to weeks.  

To allow healing time, the device will remain off after your child’s surgery. Their first follow-up appointment will be scheduled for one week after surgery. During this appointment, their care team will check their incision sites. The device will be turned on at a later appointment, one month after surgery.   

What to expect after hypoglossal nerve implant surgery  

Your child may feel mild to moderate pain and swelling where your surgeon made the incisions for 7 to 10 days. You may give your child pain medicine as prescribed by your surgeon. Unless your surgeon instructs otherwise, they will be prescribed a safe and effective non-steroidal anti-inflammatory drug (NSAID) called celecoxib (Celebrex®). It is like ibuprofen (Motrin®) and helps with pain and swelling. You may also give your child other pain relievers like acetaminophen (Tylenol®).   

Please make sure your child:   

• Does not rub at the incisions at any time.   
• Does not shower for 24 hours after the procedure.  
• Does not go swimming or take baths until after their follow-up appointment. The incisions should not be soaked or covered in water. It is okay to let soapy water run over the incisions and surgical tape in the shower.   
• Avoids heavy lifting or strenuous activity for two weeks or until cleared by your surgeon.   

Call us right away if:  

• Your child has a fever of 102°F or higher.  
• Your child has continued vomiting at home (two or more times in one day).  
• Your child’s pain medicine is not relieving their pain.  
• You notice a lot of bleeding or drainage from your child’s incision sites.  
• There is increased pain, swelling or foul-smelling odor around the incisions.  
• If you have any questions or concerns.   

You can reach us at 215-590-3440 for questions and emergencies. We are available 24 hours a day, 7 days a week.