Laser midline glossectomy as a treatment for obstructive sleep apnea

Abstract

Multiple site specific procedures have been proposed to treat obstructive sleep apnea syndrome (OSAS). Midline glossectomy (MLG) is a procedure that directly enlarges the hypopharyngeal airspace using the carbon dioxide laser. The initial experience of 12 patients is presented. Midline glossectomy as the sole procedure was performed on 11 patients who had failed uvulopalatopharyngoplasty (UPPP) and who were felt to have significant hypopharyngeal collapse on physical examination and Müller's maneuver. One patient with primary hypopharyngeal narrowing underwent MLG. Five (42%) were considered responders with Respiratory Disturbance Index (RDI) decreasing from 60.6 per hour to 14.5 per hour. In seven nonresponders, there was no significant change in the RDI (62.6 events per hour to 48.4 events per hour). Cephalometric analysis showed that responders tended to be more retrognathic (sella-nasion-supramentale (S-N-B = 74.4 degrees)) than nonresponders (S-N-B = 79.3 degrees). Responders were significantly less obese (body mass index (BMI = 30.6)) than nonresponders (BMI = 37.9). There were five minor complications including minor bleeding (n = 3), prolonged odynophagia (n = 1), and minor change in taste (n = 1). There were no major complications, and no persistent difficulties with speech or swallowing. These results demonstrate that direct surgical modification of the tongue base and associated structures can significantly impact obstructive apnea. Midline glossectomy or similar procedures may be useful in a subset of patients with OSAS.

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

“…20 Tonsillectomy was performed simultaneously in 7 of the 12 patients. Postoperative morbidity was not quantified and 3 postoperative complications (bleeding) occurred.…”

“…[20][21][22] These procedures may be combined with partial epiglottectomy. Significant reduction in RDI has been shown for different groups of patients.…”

Non-CPAP therapies in obstructive sleep apnoea

“…It has been hypothesised that removal of a midline portion of the tongue base and excess tissue such as redundant lingual tonsils would enlarge the hypopharyngeal airway [283]. The intervention carries an inherent risk for significant postoperative pharyngolaryngeal oedema and requires a temporary tracheotomy.…”

“…The intervention carries an inherent risk for significant postoperative pharyngolaryngeal oedema and requires a temporary tracheotomy. FUJITA et al [283] and MICKELSON and ROSENTHAL [284] included patients with severe persistent OSAS after UPPP and selection was based upon clinical examination and fibre-optic laryngoscopy with Mueller manoeuvre. Side-effects were considered minor and no persistent voice changes or dysphagia were reported.…”

Long-term results in the treatment of obstructive sleep apnea

“…Results of various types of surgical procedures on the tongue have been described for treatment of patients with OSA with follow-up periods up to 24 months [11,16,20,65,94]. Because of the lack of long-term findings the second part of this review [88] considers only the two most recent papers [11,65].…”