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

Abstract

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.

Tongue Base Reduction with Temperature-controlled Radiofrequency Volumetric Tissue Reduction for Treatment of Obstructive Sleep Apnea Syndrome

“…In both studies, one serious complication occurred, namely a tongue base infection. N evertheless, in a larger series we could demonstrate that antibiotic prophylaxis reduces the number of side-effects; further tongue base infections have not been recorded (24). In the present study and in the larger series cited above we never observed any relevant postoperative complications due to deterioration of OSAS induced by tissue edema.…”

“…In a previous study we have demonstrated that the application of higher amounts of energy does not lead to relevant increases in postoperative morbidity or in the number of complications observed (24).…”

“…Preliminary results were published in D ecember 2000 (21). In this follow-up study we wanted to investigate whether the more aggressive treatment protocol used would reduce the number of treatments needed per patient and to present our nal results.…”

Current knowledge and impressions of speech-language pathologists of the swallow of persons who are obese

“…The survey was modified from other surveys used in the literature to determine knowledge or impressions of SLPs on feeding tube placement [34], written language [35] and nonspeech oral motor exercises [26]. This survey was developed using questions focused on four primary areas: personal demographics, work experience, extent of knowledge of the obese swallow and impressions of the obese swallow.…”

“…Although there are different surgical techniques for treatment of OSAS (e.g. uvulopalatopharyngoplasty), existing research has not objectively addressed differences in swallowing, speech or taste pre-surgery and postsurgery but instead has used subjective means of determining differences [25][26][27][28]. More research is needed to compare the swallow (and speech) of persons who are obese and present with OSAS and their typical-weight counterparts to determine if objective differences exist.…”