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

Abstract

In recent years a considerable effort has been made to establish the use of different surgical techniques for the treatment of obstructive sleep apnea syndrome (OSAS). Nevertheless, treatment of hypopharyngeal obstruction due to tongue base hypertrophy remains in many ways an unsolved problem. The aim of this study was to evaluate the safety and efficacy of tongue base reduction with temperature-controlled radiofrequency volumetric tissue reduction in the treatment of OSAS. Twenty patients with OSAS and tongue base hypertrophy were treated with radiofrequency tissue ablation. An intensified treatment protocol was used, delivering 2,800 J per treatment session under local anesthesia. Two nights of polysomnography testing were performed before and after treatment. Daytime sleepiness, snoring and postoperative morbidity were assessed using questionnaires. Mean respiratory disturbance index (RDI) was reduced from 32.1 to 24.9/h after a mean of 3.4 treatment sessions. Six patients (33%) were cured after the procedure (reduction in RDI of > or = 50% and a postoperative RDI of < 15/h) and ten (55%) showed an improvement of > 20% in their RDI. Daytime sleepiness and snoring improved significantly. Peri- and postoperative morbidity was low; one severe complication occurred (tongue base abscess). We were able to achieve similar cure and responder rates to those reported in a recently published pilot study but with a reduced number of treatment sessions. We believe that this technique may improve patient acceptance and have beneficial cost implications.

Non-CPAP therapies in obstructive sleep apnoea

“…Although the AHI did not improve in the radiofrequency group, subjective and functional outcome measures improved significantly. Postoperative pain appears to be comparable to UPPP with tonsillectomy [263]. The postoperative complication rate varies between 0 and 41%, and is mostly below 5% [229,232,233,263,[267][268][269][270].…”

“…Postoperative pain appears to be comparable to UPPP with tonsillectomy [263]. The postoperative complication rate varies between 0 and 41%, and is mostly below 5% [229,232,233,263,[267][268][269][270]. A severe potential complication is the formation of an abscess of the tongue base [229,232,262,271].…”

“…All studies have shown a statistically significant reduction in daytime sleepiness and all but two demonstrated a statistically significant reduction in AHI, although the overall effect seems limited (table e24) [262,263]. Most trials presented follow-up periods of between 1 and 4 months.…”

“…A severe potential complication is the formation of an abscess of the tongue base [229,232,262,271]. No changes of swallowing or speech were observed [232,263,267,271]. The addition of radiofrequency surgery to other surgical approaches, such as UPPP, nasal surgery, tonsillar surgery, palatal implants or hyoid suspension, did not lead to an increase in morbidity [270,[272][273][274][275][276][277].…”

Transoral Robotic Tongue Base Resection in Obstructive Sleep Apnoea-Hypopnoea Syndrome: A Preliminary Report

“…Minimally invasive techniques are not sufficient to satisfactorily manage these kinds of patients. Reports in the literature do not directly address the problem of huge tongue base hypertrophy and limit their evaluations to a generic retrolingual collapse [13,14] . Furthermore, the 3-D array of the tongue base associated with its complex relationships to surrounding structures and its critical physiological functions make tongue base surgery technically demanding and encumbered with complications that are not insignificant.…”