About this page. Detailed consent information for shortening of the glossoepiglottic ligament — a relatively unusual sleep-surgery procedure that is only offered after careful airway assessment, usually including DISE. Please raise any questions at your pre-operative appointment.
What the Operation Is
The glossoepiglottic ligament is a small but important structure that connects the base of the tongue (gloss/o, meaning tongue) to the front surface of the epiglottis. The epiglottis is the leaf-shaped flap of cartilage that covers the windpipe (trachea) during swallowing, protecting the airway from food and liquid.
In some patients with obstructive sleep apnoea, the epiglottis collapses backwards into the airway during inspiration — the so-called "trapdoor phenomenon" — closing off the breathing space. This pattern of obstruction is identified on drug-induced sleep endoscopy. In selected patients, shortening the glossoepiglottic ligament tethers the epiglottis forward into a more stable position, reducing its tendency to collapse posteriorly during sleep.
This is a specialist procedure that I perform only after careful assessment. Many patients with epiglottic collapse are better managed by treating other levels of obstruction (palate, tongue base, lateral pharyngeal walls) first; epiglottic surgery is generally reserved for patients in whom epiglottic collapse remains a major contributor despite optimal treatment of the rest of the airway.
Video Guide
The video below shows this operation being performed. It is not for the squeamish.
Risks & Complications
1. Infection, bleeding, and airway compromise
Any surgical intervention involving the epiglottis carries a risk of infection and bleeding. Because the epiglottis sits immediately above the entrance to the airway, swelling caused by infection or bleeding can obstruct breathing. Severe airway swelling is a life-threatening emergency requiring urgent hospital management — oxygen therapy, intravenous antibiotics, occasionally an emergency airway procedure. The risk is small but it is the single most important reason this operation is offered selectively.
If after the operation you develop noisy breathing, difficulty breathing, drooling, or worsening pain on swallowing — attend A&E urgently or call 999. Airway swelling can progress rapidly and must not be ignored.
2. Worsening of the "trapdoor phenomenon" and sleep apnoea
In a small number of cases, surgery in this area can paradoxically worsen rather than improve epiglottic collapse — for example, if scarring forms in an unhelpful direction. Pre-existing OSA may become more severe rather than better. This is one of the reasons careful patient selection is essential.
3. Epiglottis damage and secondary infection
There is a small risk of direct damage to the epiglottis during surgery, which can increase the likelihood of secondary infection. Established infection at this site may require prolonged antibiotic therapy and occasionally surgical drainage. Smokers are at significantly higher risk and should stop smoking at least three months before surgery.
4. Long-term aspiration and swallowing difficulty
The epiglottis plays a vital role in protecting the airway during swallowing. If its function is impaired by surgery, there is a risk of aspiration — the accidental inhalation of food, liquid or saliva into the lungs. Mild transient aspiration is usually self-limiting; severe persistent aspiration can lead to recurrent chest infections, chronic lung disease, and in extreme cases the need for alternative feeding methods such as a feeding tube. This is rare but a serious consideration, and is why this procedure is offered only after careful airway assessment.
5. Pain
Post-operative pain is common but usually moderate. Paracetamol is sufficient in most cases; ibuprofen can be added if needed; stronger painkillers are rarely required. Pain typically settles within a week to ten days.
6. Voice change and globus sensation
A temporary change in voice quality is possible as the post-operative swelling settles, usually resolving within a few weeks. A globus sensation (lump in the throat) for a few weeks after surgery is common; it reflects local swelling and scar tissue formation, and almost always settles spontaneously.
7. Anaesthetic risks
As with any operation under general anaesthetic, there are standard anaesthetic risks, which the anaesthetist will discuss with you separately.
Aftercare
- Pain control. Paracetamol is usually sufficient; ibuprofen can be added if required.
- Diet. Soft diet for the first 24–48 hours; progress to normal food as comfortable. Eat slowly and sit upright during meals for the first week.
- Time off work. One to two weeks for most patients.
- Sleep position. Sleeping with the head of the bed slightly elevated reduces reflux onto the operative site and improves comfort.
- Avoid strenuous exercise for two weeks.
- No smoking or vaping — at least three months before and ideally permanently afterwards.
When to Call the Hospital or Attend A&E
- Difficulty breathing, noisy breathing, drooling, or feeling that the airway is closing — call 999.
- Repeated coughing during or after meals (possible aspiration).
- Worsening pain after the first few days.
- Fever above 38.5°C that does not settle.
- Fresh red bleeding from the mouth.
Booking, Consent and Next Steps
This is a specialist procedure offered only after detailed assessment of your airway. If you have been told you have epiglottic collapse on a sleep endoscopy and would like to discuss whether this operation is suitable, the secretarial team can arrange a consultation. See also DISE & PTLTbE and Snoring & OSA for related reading.