Ultrasound-guided radiofrequency submucosal tongue-base excision for sleep apnoea: a preliminary report1

Abstract

Surgery for sleep apnoea is challenging, particularly in patients with macroglossia. This has led us to develop a new procedure for reduction of the tongue base with low morbidity. Two types of bipolar radiofrequency probe were used via a percutaneous approach under an aseptic technique and general anaesthesia on 15 consecutive patients with retropalatal and retrolingual collapse. The lingual neurovascular bundles and probe were simultaneously identified with intraoperative real-time ultrasound to prevent neurovascular damage, and five patients had additional tongue mucosal suture advancement. All patients had previous or concurrent palatal surgery. The increase in cephalometric (retrolingual) posterior airspace (PAS) was 4 mm with a Spinevac wand and mucosal suture advancement, which is comparable to current-staged monopolar radiofrequency protocols requiring treatment for up to 6 months. Overall, 40% polysomnographic success was achieved, but it was 80% when additional phase 1 procedures were used. Morbidity was minimal with careful adherence to the perioperative care protocol.

ENT-specific therapy of obstructive sleep apnoea in adults

“…The muscular volume reductions of the tongue are subdivided into transoral open [53][54][55], transoral submucosal [56], transcollar submucosal [57] and transcollar open approaches [58]. The open techniques have to be linked in part with a temporary tracheostomy.…”

“…The open techniques have to be linked in part with a temporary tracheostomy. Employing radiofrequency techniques [56,57,60] seems to make tracheostomy unnecessary. Employing radiofrequency techniques [56,57,60] seems to make tracheostomy unnecessary.…”

Potential therapeutic targets in obstructive sleep apnoea

“…OSA is characterised by repetitive episodes of ‘valve-like’ pharyngeal closure during sleep [21] with a resulting decrease in oxygen saturation and hypercapnia. Contributors to collapse of the upper airway include a combination of constricted space due to upper airway anatomy [22-25], impaired neuromuscular drive [26-28], intraluminal negative (sub-atmospheric) pressure, and external influences on the pharyngeal space (such as extraluminal tissue pressure) [29,30]. With compromised stabilisation of the airway walls and increasing negative pressure behind the soft palate, pharyngeal obstruction is common [31-37].…”

The Effect of Glossectomy for Obstructive Sleep Apnea

“…Comparison of means reveals a statistically significant improvement in ESS, 11.41 6 4.38 to 5.66 6 3.29 (P \ .001) from baseline to follow-up. Pooled analysis also shows a significant improvement in ESS, -5.49 (95% CI, -7.17 to 23.81) (Figure 3).LSATFifteen studies,[12][13][14]21,22,[24][25][26][27][28][29][30][31][32][33] totaling 414 patients, recorded pre-and postoperative LSAT. Comparison of means reveals statistically significant improvement in LSAT, 76.67% 6 10.58% to 84.09% 6 7.90% (P \ .001), from baseline to follow-up.…”