A Standardized Lingual Tonsil Grading System

Friedman, Michael; Yalamanchali, Sreeya; Gorelick, Gleb; Joseph, Ninos J.; Hwang, Michelle S.

doi:10.1177/0194599815568970

Cited by 47 publications

(13 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Comparing preoperative and postoperative changes in the success and failure groups showed that the RG area, RG volume, and total volume were significantly larger in the success group than in the failure group ( p = 0.04, 0.001, and 0.02, respectively) ( Table 3 ). Further outcome analysis based on lingual tonsil grading [ 15 ], revealed that all patients in the success group had non-hypertrophic lingual tonsils (Gr I/II, n = 8). By contrast, three patients in failure group had hypertrophic lingual tonsils (Gr III/IV), and only one patient had a Gr I lingual tonsil.…”

Section: Resultsmentioning

confidence: 99%

Volumetric Changes after Coblation Ablation Tongue (CAT) in Obstructive Sleep Apnea Patients

Chiang

2022

JCM

View full text Add to dashboard Cite

Background: Obstruction of the tongue is commonly seen in patients with obstructive sleep apnea (OSA). This study proposed whole tongue treatment using coblation ablation tongue (CAT) and aimed to explore the potential association between the dimensions of a tongue and the severity of OSA, to inspect volumetric changes of the tongue after CAT, and to search for factors that influence outcome of tongue volume change. Methods: The prospective study enrolled 12 OSA patients (all male, average age: 35 years, average apnea/hypopnea index (AHI): 45.5 event/h, average body mass index (BMI): 27.0 kg/m2). All patients received multi-level sleep surgery including septomeatoplasty, uvulopalatopharyngoplasty, and CAT. The CAT used a coblation wand to perform uniform multiple ablations (15 points, body −6, base −9) on dorsal tongue. Three dimensions of the tongue (length, height, and width) and tongue volume were measured from head and neck computed tomography. The perioperative changes in the tongue dimension/volume and AHI were assessed at baseline and 3 months after surgery. Result: The baseline tongue length and AHI had a significant correlation (r = 0.60, p = 0.02). The multi-level surgery significantly improved AHI (43.8 vs. 23.7, p = 0.008). The CAT significantly decreased tongue volume from 91.3 to 85.6 cm3 (p = 0.02), with an average tongue volume reduction of 5.7 cm3 per person and 0.38 cm3 per ablation. Further outcome analysis showed surgical success was significantly higher in patients with non-hypertrophic lingual tonsils (grade I/II) than in those with hypertrophic lingual tonsils (grade III/IV) (p = 0.02). Conclusion: Length of the tongue is associated with the severity of OSA. The CAT significantly decreased the tongue volume in OSA patients. A volumetric reduction of 0.38 cm3 per ablation could be useful in the optimal reduction of tongue for OSA. The CAT significantly enlarged the retroglossal airway volume, which is related to the non-hypertrophic lingual tonsil.

show abstract

Section: Resultsmentioning

confidence: 99%

Volumetric Changes after Coblation Ablation Tongue (CAT) in Obstructive Sleep Apnea Patients

Chiang

2022

JCM

View full text Add to dashboard Cite

show abstract

“…It may also correlate with chronic infections, allergy, gastroesophageal reflux, and obesity [1,5,7]. When associated with allergic rhinitis, for example, LTH is more extensive, covering the entire base of the tongue (grade 3) [8,9]. LTH in adults is mostly asymptomatic.…”

Section: Discussionmentioning

confidence: 99%

An Uncommon Case of Partial Airway Obstruction due to Lingual Tonsillar Hypertrophy

Mukherjee¹,

Ghosh²,

Anandam³

2020

Cureus

View full text Add to dashboard Cite

Obstruction of the airway is a medical emergency. If it is not treated immediately, rapid and potentially life-threatening hypoxia develops. A 70-year-old woman with a history of hypertension and palatine tonsillectomy presented to our tertiary care hospital with dysphagia, odynophagia, muffled voice, and neck swelling of a one-week duration. She also complained of associated shortness of breath that began two days prior to hospital admittance. Bedside laryngoscopy revealed an enlarged base of the tongue and laryngeal edema, resulting in partial airway obstruction. A CT scan of the soft tissue of the neck revealed that lingual tonsillar hypertrophy (LTH) was the cause of the partial airway obstruction. While being closely monitored, the patient was treated with intravenous corticosteroids and antibiotics. Serial laryngoscopies were performed to track the resolution of the airway obstruction. Her hospital course remained uneventful, and the patient was discharged after four days. Though rare, LTH has a strong propensity to cause airway compromise, and it must be treated at once.

show abstract

“…Due to the concurrent palatal obstruction shown in the DISE, UPPP was performed simultaneously. In addition, a reduction (ablation) in the volume of the hypertrophic lingual tonsil (grade [ 25 ] III-IV) was also implemented using coblation [ 26 ] or electrocautery ( n = 8).…”

Section: Methodsmentioning

confidence: 99%

Transoral Tongue Suspension for Obstructive Sleep Apnea—A Preliminary Study

Hsin

Lee

Lin

et al. 2022

JCM

View full text Add to dashboard Cite

Objectives: To evaluate the safety and efficacy of a novel technique for transoral tongue suspension (TOTS) in obstructive sleep apnea (OSA) patients. Material and Methods: The retrospective study enrolled 24 consecutive OSA patients (21 males; average age, 43 years; average apnea–hypopnea index (AHI), 42.2 event/h; average body mass index (BMI), 25.7 kg/m2) with tongue obstruction confirmed by drug-induced sleep endoscopy. All patients received TOTS as the main procedure in conjunction with uvulopalatopharyngoplasty (UPPP). Key procedures of TOTS included a transoral sublabial approach, drilling two holes on the mandible, passing the polypropylene through the hole to the tongue base using a suture passer and returning the polypropylene through loop traction, and tying the polypropylene to the mandible. Lingual tonsil ablation (n = 8) was also implemented in hypertrophic lingual tonsils (grades III and IV). Results: The operation time for TOTS was around 30 min. No wound bleeding or airway compromise occurred throughout the postoperative period. Minor complications were temporary and included swelling of the tongue, numbness of the lower incisor, and sublabial wound dehiscence (n = 2). The quality of life improved significantly in the patients’ subjective daytime sleepiness according to the Epworth Sleepiness Scale (11.4 ± 3.2 vs. 5.7 ± 1.6, p < 0.001). The objective parameters of OSA also improved significantly in the apnea/hypopnea index (42.2 ± 21.8 vs. 19.5 ± 16.2, p < 0.001), minimal oxygen saturation (77.1 ± 12.2 vs. 81.7 ± 8.1, p = 0.026), and snoring index (207 ± 141 vs. 101 ± 91, p = 0.03). Conclusions: The demonstrated TOTS showed its advantage in low morbidity with a scarless exterior and easy performance with free availability in treating adult OSA patients with tongue obstruction. TOTS combined with UPPP significantly improved AHI and daytime sleepiness. TOTS can be implemented with lingual tonsillectomy to achieve both stabilization of the tongue and widening of hypopharyngeal airway.

show abstract

A Standardized Lingual Tonsil Grading System

Abstract: The substantial interexaminer correlation demonstrated during video assessment and perfect interexaminer correlation in live assessment indicate that the proposed grading system may be a valuable and useful tool in creating a common language to describe lingual tonsils.

Cited by 47 publications

References 12 publications

Volumetric Changes after Coblation Ablation Tongue (CAT) in Obstructive Sleep Apnea Patients

Volumetric Changes after Coblation Ablation Tongue (CAT) in Obstructive Sleep Apnea Patients

An Uncommon Case of Partial Airway Obstruction due to Lingual Tonsillar Hypertrophy

Transoral Tongue Suspension for Obstructive Sleep Apnea—A Preliminary Study

Contact Info

Product

Resources

About