Bipolar radiofrequency induced thermotherapy of the tongue base: its complications, acceptance and effectiveness under local anesthesia

Abstract

We assessed adverse events and complications of bipolar radiofrequency induced thermotherapy of the tongue base (RFTB) in patients with socially unacceptable snoring (SUS) or obstructive sleep apnea syndrome (OSAS) and determine its acceptance and effectiveness when conducted under local anesthesia. This investigation consisted of (1) a prospective, open-enrollment study of 24 consecutive patients with snoring and OSAS at the tongue base level only (Fujita III), assessed by sleep endoscopy. Polysomnography, questionnaires, and visual analog scales (VAS) were used to assess outcome. (2) In addition, a retrospective review of 83 patients, who underwent RFTB (in 59 cases as part of a multilevel treatment), was performed to evaluate adverse events and complications. Twenty-two of the 24 patients completed postoperative questionnaires and VAS, and ten patients had postoperative polysomnography. Reduction in snoring (P = 0.0003), hypersomnolence (P = 0.002), and globus (P = 0.031) was significant. A positive trend in AHI (P = 0.001, n = 3) is shown in patients with moderate to severe OSAS. Concerning postoperative adverse events and complications, only two patients had a mild and transient tongue deviation directly after the procedure, which resolved within an hour postoperatively (adverse event rate 1.8%). No postoperative complications such as infections, abscesses, hematomas, or ulcerations of the tongue base occurred. This study demonstrates that bipolar RFTB in patients with obstruction at the tongue base only (Fujita type III) as visualized by sleep endoscopy is a safe and simple procedure under local anesthesia and can be effective in patients with SUS. No complications during this study were observed. Its effect on OSAS has been shown by other authors, although long-term effects are not stable. The RFTB can be considered as first choice treatment in case of snoring and mild OSAS in Fujita type III obstruction. In the case of moderate to severe sleep apnea, RFTB can be considered as an additional treatment.

Complications of hyoid suspension in the treatment of obstructive sleep apnea syndrome

“…We have published earlier reports on the results of HS [25] and on the results and complications of RFTB [16]. The results of combined HS and RF of the tongue base will be reported in the near future.…”

“…Established surgical procedures for tongue base obstruction include RFTB, HS, GA and MMA. Although RFTB has very low adverse events and complication rates, the eVect is minimal and therefore only indicated exclusively for patients with snoring or mild OSAS or as part of a combined approach [16]. There is no data on the eVectiveness of GA as an independent treatment modality.…”

“…Surgical treatments are performed based on the level of obstruction in the upper airway and vary from radiofrequency-induced thermotherapy (RFTT) of the palate or tongue base, a minimally invasive intervention [14][15][16] to uvulopalatopharyngoplasty (UPPP) [17], hyoid suspension (HS) [18], genioglossus advancement (GA) [19], maxillomandibular advancement (MMA) [20][21][22] or tracheostomy [23]. DiVerent surgical interventions can be performed in unilevel (palatal or retrolingual level only) or multilevel (both these levels) procedures, either staged or simultaneously.…”

Radiological airway changes following bipolar radiofrequency volumetric tissue reduction

“…4,15 The effect of bipolar energy application on clinical parameters has also been described and has been deemed safe and simple. [8][9][10][11][12]14 Bipolar radiofrequency volumetric tissue reduction of the tongue base uses much less energy per treatment session than monopolar application, and thus takes less time to perform. It enables precise placement of energy between two electrodes, with consequent avoidance of secondary thermal damage.…”

“…Post-operative pain is minimal, and the technique can be performed as a day-case procedure. [8][9][10][12][13][14] Until recently, most of the work published on radiofrequency volumetric tissue reduction for sleep-disordered breathing has focused on monopolar energy application. The use of monopolar radiofrequency volumetric tissue reduction to reduce lesion size and soft tissue volume has been studied extensively.…”