Pseudoaneurysm of the Lingual Artery After Temperature-Controlled Radiofrequency Tongue Base Reduction: A Severe Complication

Abstract

Temperature-controlled radiofrequency reduction (TCRF) of the tongue base has been developed as an alternative option for the treatment of patients with obstructive sleep apnea syndrome. The technique is propagated as an easy and safe surgical method. The case of a 34-year-old male patient with obstructive sleep apnea syndrome who underwent TCRF is reported. Fourteen days after surgery was performed, heavy bleeding at the base of the tongue occurred. Computed tomography and digital subtraction angiography imaging revealed a pseudoaneurysm of the lingual artery, which was treated endovascularly by detachable and free platinum coils during the same session. The article reports the first case of pseudoaneurysm under TCRF of the tongue base and discusses the diagnostic and therapeutic procedure to handle and avoid life-threatening complications under this method of treatment.

Histopathologic Evaluations of the Lingual Artery in Healthy Tongue of Adult Cadaver

“…Tongue has excellent mobility and abundant vasculatures. Massive bleeding can occur when main trunk of the lingual artery is damaged and ligation is difficult due to limited surgical field [6,7]. Thus, it is important to prevent excessive bleeding by preserving the lingual artery.…”

The definition of the V zone for the safety space of functional surgery of the tongue

“…The lingual arteries are the most susceptible structures to injury of the hypoglossal/lingual artery neurovascular bundle (HLNVB) in surgeries for the narrowing hypopharyngeal region. Thus, bleeding,6 pseudoaneurysm,7 and hematoma8 are serious complications of these surgical procedures, and can result in severe obstruction in the hypopharyngeal region. The main reason for these complications is that the course of the lingual artery is not directly visible in detail.…”

Hypertonic saline injections to enhance the radiofrequency thermal ablation effect in the treatment of base of tongue in obstructive sleep apnoea patients: a pilot study

“…However, severe complications have been encountered, i.e. base of tongue abscesses and development of a lingual artery pseudoaneurysm [18,19]. One of the serious adverse effects found in this study was the increased swelling of upper airways warranting attendance in hospital, but interventions to secure the airway were not needed.…”