Surgical Technique
After injection of local anesthetics at the predetermined surgical site, a 4-5 cm incision is made on the patient's neck just superior to the hyoid and carried down to the platysma. The platysma is then split, dissection is continued down to the hyoid bone, and the anterior portion of the hyoid is skeletonized.

Blunt dissection is continued to the predetermined screw insertion sites on the posterior aspect of the inferior border of the mandible, below each lower canine.

The Repose® Bone Screw Inserter is placed into the surgical site and manipulated into position, perpendicular to the angle of the mandible. The safety is released and the screw is inserted (Figure 2). A second sterile Repose bone screw is loaded into the inserter, and the screw is inserted at the predetermined site on the contralateral side.

Next, one of the two loops of suture is loaded and secured onto a half-curved Hyoid Needle. The needle is passed from the inferior musculature, approximately 1 cm off midline, then retrieved from the superior or supra-hyoid muscles. The suture is then passed a second time around the hyoid bone, inferior to superior, just slightly medial of the first pass. The free curved needle is now loaded onto the contralateral suture in the previously described manner. The Lahey Clamp is lowered toward the patient's chest, hyper-exposing the superior musculature. The needle is passed superior to inferior, approximately 1 cm lateral of the midline. The suture is then passed a second time around the hyoid bone, superior to inferior, just slightly medial of the first pass. After the patient is placed in normal pillow supine position, a surgeon's knot is placed on the midline and the tails are pulled in opposing directions (Figure 3), acting like a series of pulleys, they draw the hyoid up toward the mandible, approximately 8 to 10 mm (Figure 4), until the inferior midline muscles become drum tight. A single knot is thrown over the surgeon's knot, effectively locking the suspension. A suction drain, or a penrose drain is placed, and the incision is appropriately closed and dressed.