Histopathological and ultrastructural effects of cutting radiofrequency energy on palatal soft tissues: a prospective study

Abstract

Radiofrequency (RF) surgery has gained popularity as a safe and effective method for treating patients with snoring and mild obstructive sleep apnoea (OSA). Both interstitial and cutting radiofrequency energy may be used for multi-segmental management of the upper airway. Little is known about the effect of cutting radiofrequency energy on human soft palate. Excessive collateral injury may have an impact on tissue healing and functional outcomes. A histological analysis of specimens of human soft palate and uvula following resection with cutting RF energy was performed. In addition, ultrastructural analysis using scanning electron microscopy of excision margins was performed and compared with CO(2) LASER. Twelve patients were included. In ten patients, specimens of redundant uvula and faucial pillars were collected and underwent formal histological analysis. The maximum depth of tissue injury was 1 mm in two specimens and overall average depth of injury was 0.15 mm. Injury depth was independent of tissue subtype at the resection margin. Ultrastructural analysis demonstrated accurate incision when compared to CO(2) LASER. Cutting RF energy causes minimal collateral injury to the soft palate during resection for the treatment of snoring and mild OSA. A detailed knowledge of local effects on resection specimens allows accurate inference of in vivo tissue injury at the resection margin and may enable more precise prediction of healing patterns and repair.

Surgical management of airway stenosis by radiofrequency coblation

“…In addition, with lasers operating in the presence of high concentrations of inspired oxygen (used in jet ventilation) and at temperatures upwards of 400-600°C, there is a real risk of airway fire associated with laser resection. 23 Such a complication is associated with severe morbidity and mortality. [24][25][26] Jet ventilation was introduced in 1970 as an alternative to traditional tracheal tube ventilation in microlaryngoscopy.…”

“…This decline was primarily a result of the effect of re-scarring and the need for repeat procedures. In addition, with lasers operating in the presence of high concentrations of inspired oxygen (used in jet ventilation) and at temperatures upwards of 400–600°C, there is a real risk of airway fire associated with laser resection 23 . Such a complication is associated with severe morbidity and mortality 24 – 26 …”

Radiofrequency ablation in snoring surgery: local tissue effects and safety measures

“…complications are uncommon, but include bleeding, infection, fistulation, ulceration, tongue weakness and taste disturbance alongside globus sensation, which may persist in the long term in up to 10 % of patients ( Fig. 1) [4][5][6][7][8].…”

“…Radiofrequency treatments are minimally invasive and can be applied interstitially or in cutting mode to resect excess palatal tissue, thus enabling concomitant applications to the soft palate, base of tongue and resection of redundant palatopharyngeus mucosa. Due to its inherent safety profile, these procedures can be performed under local anaesthetic in outpatient departments [1][2][3][4][5].…”

Minimally Invasive Radiofrequency Surgery in Sleep-Disordered Breathing

“…Radiofrequency can be used to fibrose tissue but also as a cutting technique with minimal collateral damage [6]. Radiofrequency acts without stimulating nerves and muscle, which allows it to be used without general anaesthetic in the clinic setting [4].…”