A systematic review of tongue base suspension techniques as an isolated procedure or combined with uvulopalatopharyngoplasty in obstructive sleep apnea

Abstract

We aimed to evaluate existing research into the effectiveness and safety of two tongue base suspension (TBS) techniques (Repose(®) system and modified TBS) with or without uvulopalatopharyngoplasty (UPPP) in obstructive sleep apnea. The literature review was performed using PubMed database. Searched terms used included the keywords "sleep apnea", "surgery", "tongue", "tongue base", "suspension", "Repose", "uvulopalatopharyngoplasty", and "hypopharynx". Levels of evidences and grades of recommendations were determined according to the hierarchy proposed by Oxford Centre for Evidence-based Medicine. Seven studies including 113 patients met the eligibility criteria for TBS as a stand-alone procedure. Four of seven studies including 62 patients used the Repose(®), and three studies including 51 patients used the modified TBS. The success rates were higher in the studies that used modified technique (74.5 %) than those that used the Repose(®) (25.8 %), (p < 0.001). Ten studies including 300 patients met the eligibility criteria for TBS combined with UPPP. Seven of ten studies including 176 patients used the Repose(®), and three studies including 124 patients used the modified TBS. The success rates in this group were similar between the modified TBS (73.4 %) and Repose(®) (67.6 %), (p = 0.341). When aggregate data of 413 patients were compared, the modified TBS was found to be associated with significantly higher success rates (73.7 vs. 56.7 %, p < 0.001). The evidence supports primarily grade C recommendations for the benefits of both techniques with or without UPPP; although there is a trend toward improved outcome with modified technique.

The effect of tongue base suspension with uvulopalato-pharyngoplasty on sleep quality in obstructive sleep apnea

“…Tongue base suspension with UPPP has had a 70% (20–88.9%) success rate in patients with OSA, and a long-term success rate of 78% when combined with nasal surgery 12 , 19 , 20 . However, the anatomical base selection of patients has been insufficiently explored; only one long-term study on tongue base suspension and pharyngeal surgery with a 2-year follow-up period reported a 52% success rate.…”

“…Tongue base suspension is beneficial in patients with OSA who are also diagnosed with tongue base collapse, tongue base atonia, glossoptosis, or an anatomically bulky tongue base 11 . In one study, the surgical success rate during a 3–36-month follow-up period with grade C recommendation was 73.7% 12 . Elsewhere, the retropalatal and retrolingual collapse decreased and spaces increased after tongue base suspension with UPPP 13 .…”

A novel implantable device for the treatment of obstructive sleep apnea: clinical safety and feasibility

“…The risk profile with this intervention is similar to or better than with other implants for the tongue (complication rates of 15%–30% for tongue-base suspension and 0%–33% for tongue-base suspension with uvulopalatopharyngoplasty, and ∼25% for mandible tethering) and has a lower morbidity profile than other more invasive surgical methods, although it is recognized that the rate of complications and long-term negative consequences of surgical interventions for OSA is poorly characterized. 45 – 47 Thus, the risks with this novel implant are considered to be acceptable as compared to other surgical approaches treating sleep apnea. Lastly, and perhaps most importantly, no subjects reported instances of foreign-body sensation, swallowing insufficiency, tongue mobility effects, or speech impediments, unlike with other procedures.…”

Pediatric Tongue Base Suspension With Fluoroscopic Guidance

“…1 Management of tongue base obstruction may include lingual tonsillectomy, posterior midline glossectomy, epiglottopexy, tongue-lip adhesion, hyoid suspension, hypoglossal nerve stimulation, and tongue base suspension. Several studies have analyzed outcomes of tongue base suspension in adults, 2 but limited data exists for the pediatric population. Tongue base suspension is technically challenging and in order to develop surgical expertise, surgeons must be exposed to a high volume of patients with complex OSA.…”