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However, non\u2010compliance leads to a high abandon rate (27\u201346%). While there are multiple sites of airway obstruction during sleep, the tongue base is recognized as the key player in the pathogenesis of OSA. Poor outcomes of current tongue suspension devices are due to fracture, slippage or migration of devices. Three tongue tethering device groups, namely a polydioxanone\/polyurethane combination (PDO\u2009+\u2009PU) treatment group, a PDO analytical control group, and a polypropylene (PP) descriptive control group, were implanted into 22 sheep (75\u201385\u2009kg) in a two\u2010phased study. After implant times of 8, 16, and 32\u2009weeks, sheep were serially euthanized to allow for explantation of their tongues and chins. The PDO\u2009+\u2009PU devices remodeled during the 32\u2010week implant period into a hybrid biological tendon\u2010like tether through the process of gradual degradation of the PDO and collagen deposition as shown by electrophoresis, histology and mechanical testing. The control PDO device degraded completely after 32\u2009weeks and the PP devices remained intact. The hybrid biological tendon\u2010like tether exhibited a break\u2010strength of 60\u2009N, thus exceeding the maximum force to overcome upper airway collapse.<\/jats:p>","DOI":"10.1002\/jbm.b.34765","type":"journal-article","created":{"date-parts":[[2020,12,7]],"date-time":"2020-12-07T07:52:49Z","timestamp":1607327569000},"page":"1005-1016","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["<scp>Tendon\u2010like<\/scp> tether formation for <scp>tongue\u2010base<\/scp> advancement in an ovine model using a novel implant device intended for the surgical management of obstructive sleep apnoea"],"prefix":"10.1002","volume":"109","author":[{"given":"Rushdi","family":"Hendricks","sequence":"first","affiliation":[{"name":"Division of Pulmonology, Department of Medicine University of Cape Town  Cape Town South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena","family":"Hofmann","sequence":"additional","affiliation":[{"name":"Department of Orthodontics University of Bonn  Bonn Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jade","family":"Peres","sequence":"additional","affiliation":[{"name":"Division of Cell Biology University of Cape Town  Cape Town South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sharon","family":"Prince","sequence":"additional","affiliation":[{"name":"Division of Cell Biology University of Cape Town  Cape Town South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos","family":"Hille","sequence":"additional","affiliation":[{"name":"Department of Oral &amp; Maxillofacial Pathology University of the Western Cape and NHLS Tygerberg Laboratories  Cape Town South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neil H.","family":"Davies","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Unit, Department of Surgery University of Cape Town  Cape Town South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8052-7491","authenticated-orcid":false,"given":"Deon","family":"Bezuidenhout","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Unit, Department of Surgery University of Cape Town  Cape Town South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,12,6]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/014556139307200106"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2015.15"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(15)00051-X"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(19)30198-5"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.2109080"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2002-32318"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccm.2010.02.010"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.27497"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2006-1699"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.159.6.9809052"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200412-1631SO"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.23301"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1155\/2008\/534372"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.159.4.9807111"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1159\/000322838"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/29.3.381"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/thx.52.1.72"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1067\/mhn.2002.123548"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.132.2.206"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjoto.2008.08.006"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.22173"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2009.02.010"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1067\/mhn.2000.102119"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.24187"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0194-59980300728-9"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2010.06.902"},{"key":"e_1_2_9_28_1","unstructured":"HealthCareHP.Medical Policy Obstructive Sleep Apnea Surgeries 2019.https:\/\/www.harvardpilgrim.org\/pls\/portal\/docs\/page\/providers\/medmgmt\/medical_clinicalpolicies\/osa_surg_rrp_10jul19.pdf. 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