Submucosal Minimally Invasive Lingual Excision: An Effective, Novel Surgery for Pediatric Tongue Base Reduction

Abstract

SMILE is an effective novel operation that incorporates coblation with ultrasonography and endoscopic guidance for children who need tongue base reduction. Anatomic dissection and clinical cases demonstrate the potential for aggressive yet relatively safe tissue removal by this minimally invasive technique. SMILE also has significant potential for adults with obstructive sleep apnea due to a large tongue base.

An Update on the Management of Pediatric Obstructive Sleep Apnea

“…Furthermore, the long-term impact of MAA on dental alveolar anatomy and mandibular growth is unknown. [38] and submucosal tongue base reduction [39] can be used to treat OSA in children.…”

Surgical management of sleep-disordered breathing in children

“…48,49 One approach involves a small anterior tongue incision, tunneling posteriorly, and submucosally ablating the hypertrophic tissue. 50 Midline posterior glossectomy has been used in drug-induced sleep endoscopy-directed treatment of pediatric OSA. 51 Tongue base suspension has been used in children with complex OSA and cerebral palsy.…”

Low-Temperature Bipolar Radiofrequency Ablation (Coblation) of the Tongue Base for Supine-Position-Associated Obstructive Sleep Apnea

“…SMILE has adverse effects, like hypoglossal nerve injury and edema on the tongue base in the postoperative period, although it is less invasive and more successful than RFBOT [7] . Lingual artery damage is also a serious side effect of this method, but its incidence has diminished significantly with the ultrasonographically guided method utilized by Maturo and Mair [10] .…”

“…The Coblation procedure, a modification of the submucosal minimally invasive lingual excision (SMILE) procedure defined by Maturo and Mair [10] , was performed as described later.…”