Efficacy of Coblation Endoscopic Lingual Lightening in Multilevel Surgery for Obstructive Sleep Apnea

Li, Hsueh‐Yu; Lee, Li‐Ang; Kezirian, Eric J.

doi:10.1001/jamaoto.2015.3859

Cited by 28 publications

(24 citation statements)

References 27 publications

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“…Obstruction of the lateral pharyngeal wall (LPW) occurred in nearly half of our patients, which is consistent to reports on DISE 23 . Collapses in the LPW of the hypopharynx are difficult to approach using traditional UPPP, which limits its use for patients with OSA.…”

Section: Discussionsupporting

confidence: 92%

Dynamic Drug-Induced Sleep Computed Tomography in Adults With Obstructive Sleep Apnea

Hsin

et al. 2016

Sci Rep

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Surgical success for obstructive sleep apnea (OSA) depends on identifying sites of obstruction in the upper airway. In this study, we investigated sites of obstruction by evaluating dynamic changes in the upper airway using drug-induced sleep computed tomography (DI-SCT) in patients with OSA. Thirty-five adult patients with OSA were prospectively enrolled. Sleep was induced with propofol under light sedation (bispectral index 70–75), and low-dose 320-detector row CT was performed for 10 seconds over a span of 2–3 respiratory cycles with supporting a continuous positive airway pressure model. Most (89%) of the patients had multi-level obstructions. Total obstruction most commonly occurred in the velum (86%), followed by the tongue (57%), oropharyngeal lateral wall (49%), and epiglottis (26%). There were two types of anterior-posterior obstruction of the soft palate, uvular (94%) and velar (6%), and three types of tongue obstruction, upper (30%), lower (37%), and upper plus lower obstruction (33%). DI-SCT is a fast and safe tool to identify simulated sleep airway obstruction in patients with OSA. It provides data on dynamic airway movement in the sagittal view which can be used to differentiate palate and tongue obstructions, and this can be helpful when planning surgery for patients with OSA.

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Section: Discussionsupporting

confidence: 92%

Dynamic Drug-Induced Sleep Computed Tomography in Adults With Obstructive Sleep Apnea

Hsin

et al. 2016

Sci Rep

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“…Endoscopic coblation assisted tongue base reduction surgery was performed similar to previous reports (Wee et al, 2015; Li, Lee & Kezirian, 2016a; Li, Lee & Kezirian, 2016b). Under general anesthesia with nasotracheal intubation, the Molt mouth gag ( Sklar , West Chester, PA, USA) was applied to the left side of labial commissure.…”

Section: Methodsmentioning

confidence: 89%

“…Nevertheless, the high cost of TORS makes operators and patients hesitant to use it (Cammaroto et al, 2017). Endoscopic coblation assisted tongue base reduction surgery has been reported to be a useful procedure for tongue base obstruction and it has a lower cost compared to TORS (Friedman et al, 2012; Li, Lee & Kezirian, 2016a; Li, Lee & Kezirian, 2016b). However, there is a lack of fair comparison studies regarding the treatment efficacy and safety between TORS and coblation assisted tongue base reduction.…”

Section: Introductionmentioning

confidence: 99%

Trans-oral robotic surgery versus coblation tongue base reduction for obstructive sleep apnea syndrome

Lan

Chang

Tsai

et al. 2019

PeerJ

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Objectives To compare the efficacy of trans-oral robotic surgery (TORS) with that of coblation assisted tongue base reduction surgery in patients with obstructive sleep apnea syndrome (OSAS). Subjects and Methods The medical charts were retrospectively reviewed for all OSAS patients admitted to one institution for surgical intervention between 2012 and 2017. We analyzed 33 cases; 16 patients received TORS and 17 received coblation surgery for tongue base reduction. Both groups received concomitant uvulopalatoplasty. Surgical outcomes were evaluated by comparing the initial polysomnography (PSG) parameters with the follow-up PSG data (at least 3 months after the surgery). Epworth sleepiness scale (ESS) and complications were also compared between the 2 groups. Results The success rate (≥50% reduction of pre-operative AHI and post-operative AHI <20) in the TORS group and coblation group were 50% and 58%, respectively, and there was no significant difference (p = .611). The AHI (mean ± SD) reduction in the TORS and coblation groups were 24.9 ± 26.5 events/h and 19.4 ± 24.8 events/h, respectively; the between-group difference was not significant (p = .631). ESS improvement did not differ significantly between the TORS and coblation groups (3.8 ± 6.6 and 3.1 ± 9.2, respectively, p = .873). The rates of minor complication were higher in the TORS group (50%) than that of the coblation group (35.3%) without statistical significance (p = .393). Conclusion TORS achieved comparable surgical outcomes compared to coblation assisted tongue base reduction surgery in OSAS patients. Multilevel surgery using either TORS or coblation tongue base reduction combined with uvulopalatoplasty is an effective approach for the management of OSAS.

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“…OSA patients with tongue collapse can be treated by CPAP as the first priority and salvaged by surgery. Tongue base obstruction from lingual tonsil hypertrophy (LTH) grade III or IV can be excised through trans-oral robotic surgery or coblation endoscopic lingual lightening [42] , [43] , [44] . By contrast, small and collapsible tongue with retrognathia can be treated successfully through Repose tongue base suspension.…”

Section: Intrapharyngeal Surgery By Mini-invasive Reconstructionmentioning

confidence: 99%

Intrapharyngeal surgery with integrated treatment for obstructive sleep apnea

Lee

Hsin

et al. 2019

Biomedical Journal

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Obstructive sleep apnea (OSA) is a common disease in adults, which influences human relations, quality of life and associates with major complications. Continuous positive airway pressure (CPAP) is the gold standard treatment modality in OSA patients. For patients incompliant or unwilling to CPAP therapy, surgery is an alternative treatment. Sleep surgery for OSA include intrapharyngeal surgery, extrapharyngeal surgery and bariatric surgery addressing upper airway soft tissue, maxillofacial bone, and obesity, respectively. Among sleep surgeries, intrapharyngeal surgery (soft tissue surgery) is widespread used and serves overwhelming majority in OSA surgical patients. Despite the popularity of intrapharyngeal surgery, its outcomes can be influenced by multiple factors and consequently need conjunctive remedy to enhance at the short-term and sustain in the long-term. In this article, we introduce updated indications for treating OSA, practical principle in decision-making between CPAP and surgery, hybrid procedures in treating obstruction at the nose, palate, tongue and epiglottis, and postoperative integrated treatment including oropharyngeal myofunctional therapy (local), positional therapy (regional), and body weight reduction (systemic), and circadian rhythm (central). In summary, intrapharyngeal surgery is a target-oriented procedure that needs to be performed precisely and combines with integrated treatment as a holistic care for OSA patients.

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Efficacy of Coblation Endoscopic Lingual Lightening in Multilevel Surgery for Obstructive Sleep Apnea

Abstract: Without increasing complications, combined CELL and relocation pharyngoplasty achieved greater AHI reduction and a higher surgical response rate among adults with OSA and Friedman stage III compared with relocation pharyngoplasty alone.

Cited by 28 publications

References 27 publications

Dynamic Drug-Induced Sleep Computed Tomography in Adults With Obstructive Sleep Apnea

Dynamic Drug-Induced Sleep Computed Tomography in Adults With Obstructive Sleep Apnea

Trans-oral robotic surgery versus coblation tongue base reduction for obstructive sleep apnea syndrome

Intrapharyngeal surgery with integrated treatment for obstructive sleep apnea

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