Midline Glossectomy and Epiglottidectomy for Obstructive Sleep Apnea Syndrome

Mickelson, Samuel A.; Rosenthal, León

doi:10.1097/00005537-199705000-00011

Cited by 98 publications

(70 citation statements)

References 12 publications

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“…Mickelson et al, in perfoming midline glossectomy combined with epiglottectomy, 21 could not demonstrate such a convincing reduction in RDI in their study with 12 patients. The cure rate was reported to be only 25%, with a mean RDI reduced from 48.9 to 35.7/h.…”

Section: Methods Of Tongue Base Resectionmentioning

confidence: 71%

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Tongue Base Reduction with Radiofrequency Tissue Ablation: Preliminary Results after Two Treatment Sessions

2000

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Over the last few years, different surgical techniques for the treatment of obstructive sleep apnea syndrome have been developed. While new methods for the treatment of velopharyngeal obstruction turned out to be safe and effective, treatment of hypopharyngeal obstruction due to tongue base hypertrophy has remained, in many aspects, an unsolved problem. Surgical techniques for partial resection of the tongue base (midline glossectomy, lingualplasty) are effective but very invasive procedures requiring temporary tracheotomy, and have high postoperative morbidity. A maxillofacial approach showed significant reduction in the Respiratory Disturbance Index (RDI), especially when bimaxillar osteotomies are performed. Along with the concerns of postoperative morbidity, these techniques require general anesthesia and hospitalization. Tongue base reduction with temperature-controlled radiofrequency tissue ablation was introduced in 1998, and has proven to be a safe and simple procedure. Significant reduction in RDI has been shown in the majority of the treated patients. This procedure does not require general anesthesia and has low postoperative morbidity. For curative results, tongue base reduction with radiofrequency requires multiple treatment sessions. The goal of the present study is to investigate the beneficial effect of increased amount of energy applied per treatment session, reducing the number of treatment sessions per patient. By delivering increased amounts of energy, a similar cure and/or responder rate with 2 treatment sessions, rather than 5 to 6 as published in earlier studies, was accomplished. Postoperative morbidity was similar to previously published results although there was a slight increase in postoperative complications. Apart from the reduced number of treatment sessions needed per patient, we also demonstrated the beneficial effect of prophylactic use of antibiotics in our study group. This more aggressive treatment scheme appears to be well tolerated by the patients and may be an effective means of reducing the overall number of treatments.

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Section: Methods Of Tongue Base Resectionmentioning

confidence: 71%

“…[20][21][22] These procedures may be combined with partial epiglottectomy. Significant reduction in RDI has been shown for different groups of patients.…”

Section: Tongue Base Resectionsmentioning

confidence: 99%

Tongue Base Reduction with Radiofrequency Tissue Ablation: Preliminary Results after Two Treatment Sessions

2000

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“…The intervention carries an inherent risk for significant postoperative pharyngolaryngeal oedema and requires a temporary tracheotomy. FUJITA et al [283] and MICKELSON and ROSENTHAL [284] included patients with severe persistent OSAS after UPPP and selection was based upon clinical examination and fibre-optic laryngoscopy with Mueller manoeuvre. Side-effects were considered minor and no persistent voice changes or dysphagia were reported.…”

Section: Conclusion and Recommendationsmentioning

confidence: 99%

Non-CPAP therapies in obstructive sleep apnoea

Randerath

Verbraecken²,

Andreas³

et al. 2011

Eur Respir J

311

179

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In view of the high prevalence and the relevant impairment of patients with obstructive sleep apnoea syndrome (OSAS) lots of methods are offered which promise definitive cures for or relevant improvement of OSAS.This report summarises the efficacy of alternative treatment options in OSAS.An interdisciplinary European Respiratory Society task force evaluated the scientific literature according to the standards of evidence-based medicine.Evidence supports the use of mandibular advancement devices in mild to moderate OSAS. Maxillomandibular osteotomy seems to be as efficient as continuous positive airway pressure (CPAP) in patients who refuse conservative treatment. Distraction osteogenesis is usefully applied in congenital micrognathia or midface hypoplasia. There is a trend towards improvment after weight reduction. Positional therapy is clearly inferior to CPAP and long-term compliance is poor. Drugs, nasal dilators and apnoea triggered muscle stimulation cannot be recommended as effective treatments of OSAS at the moment. Nasal surgery, radiofrequency tonsil reduction, tongue base surgery, uvulopalatal flap, laser midline glossectomy, tongue suspension and genioglossus advancement cannot be recommended as single interventions. Uvulopalatopharyngoplasty, pillar implants and hyoid suspension should only be considered in selected patients and potential benefits should be weighed against the risk of long-term side-effects. Multilevel surgery is only a salvage procedure for OSA patients.

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“…The success rate of transoral laser midline glossectomy was reported as 25% in the severe apneics [7]. When combined with lingualplasty success rate was increased to 77%.…”

Section: Discussionmentioning

confidence: 99%

Transcervical Tongue Base Reduction with Hyoepiglottoplasty: Long-Term Results

Akpınar

Gürpınar

Celikoyar

et al. 2011

Indian J Otolaryngol Head Neck Surg

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Aims To evaluate the long term results of tongue base reduction with hyoepiglottoplasty as a surgical option in the treatment of severe obstructive sleep apnea. Material and Method Severe obstructive sleep apnea patients diagnosed as upper airway narrowing at the tongue base level were treated with transcervical tongue base reduction with hyoepiglottoplasty. Seven years after single stage multilevel surgery, the patients were reevaluated clinically, radiologically and polysomnographic records were taken. Preoperative, early postoperative and long-term postoperative parameters were compared to determine the success rate of the surgical technique. Results In the postoperative long-term follow-up Epworth sleepiness scale (ESS) scores were reduced to 4 and 6 respectively 2 months after surgery despite the initial values of 17 and 15. BMI were decreased from 29.7 and 27.9 kg/m(2) respectively to 26 and 24 kg/m(2). The apnea/hypopnea index (AHI) were reduced to 14.1 and 16.2 respectively from 68.6 and 83.83. O(2) nadir was 55 and 66% respectively and improved to 86 and 89%. Flexible nasopharyngoscopy revealed competent airway in both retropalatal and retroglossal level. Bed partners scored snoring as 2/10 and 4/10 corresponding to very mild and moderate. Daytime somnolence and witnessed apneic periods were completely disappeared in both patients. Conclusion Open tongue base resection with hyoepiglottoplasty is effective among all other surgical corrections of sleep apnea even after 7 years postoperatively.

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Midline Glossectomy and Epiglottidectomy for Obstructive Sleep Apnea Syndrome

Cited by 98 publications

References 12 publications

Tongue Base Reduction with Radiofrequency Tissue Ablation: Preliminary Results after Two Treatment Sessions

Tongue Base Reduction with Radiofrequency Tissue Ablation: Preliminary Results after Two Treatment Sessions

Non-CPAP therapies in obstructive sleep apnoea

Transcervical Tongue Base Reduction with Hyoepiglottoplasty: Long-Term Results

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