Robot-assisted Tongue Base Resection ensures favorable therapeutic outcome to Obstructive Sleep Apnea patients with Lingual tonsil hypertrophy

Abstract

Tongue base (TB) narrowing is recognized as a significant site of upper airway collapse during sleep in obstructive sleep apnea (OSA) patients and robot technology is expected to have promising clinical utility in OSA patients with TB narrowing. The purpose of our study is to demonstrate the better therapeutic conditions and favorable indications of robot-assisted TB resection (TBR) in OSA. We performed robot-assisted TBR combined with nasal and palatal surgery in 16 OSA patients with any of the following characteristics: severe TB narrowing (over grade II) and moderate or severe OSA. The preoperative median AHI was 48.8/hr and the median lowest SaO2 was 82.0%. The median AHI decreased to 18.7/hr and ten patients (62.5%) were included in the responder group following robot-assisted TBR combined with nasal and palatal surgery. The lowest SaO2 improved to 90.5% and the posterior airway space (PAS) was significantly increased following robot-assisted TBR. Cephalometric results showed that wider PAS were observed in responders compared to non-responders prior to robot-assisted TBR. Interestingly, there was greater improvement in the objective parameters including PAS in the OSA patients with lingual tonsilar hypertrophy than they were in those without and all patients with lingual tonsillar hypertrophy (n = 6) responded to robot-assisted TBR. Robot-assisted TBR exhibited minimal morbidity and postoperative complications in OSA patients. Robot-assisted TBR can be considered a promising and innovative surgical option to reduce TB volume and improve sleep parameters in OSA patients with TB narrowing. OSA patient with TB narrowing due to lingual tonsil hypertrophy shows greater therapeutic outcome and lingual tonsil hypertrophy appears to be most favorable surgical indications of robot-assisted TBR.

Surgical, clinical, and functional outcomes of transoral robotic surgery used in sleep surgery for obstructive sleep apnea syndrome: A systematic review and meta‐analysis

“…The electronic search identified 140 papers, of which 31 met our inclusion criteria 16‐47 . There were 22 retrospective, 8 prospective uncontrolled studies, and one controlled randomized trial.…”

“…The surgery was proposed in patients who did not respond to a nonsurgical treatment (i.e., CPAP) 18,19,26‐29,31‐34,37,39,42‐46 and oral appliance 16,20,23,36,38,41,47 in 23 studies. In one study, the authors included patients who have never been treated by medical treatment or CPAP 21 .…”

“…The following multilevel sleep surgeries were performed in the remaining 25 cohorts: palatal (uvulopharyngopalatoplasty and/or lateral pharyngoplasty; N = 24); pharyngeal tonsillectomies ( N = 16); and nasal (septoplasty, turbinoplasty; N = 8; Table 2). The BOT resection was limited to the lymphoid tissue resection in two studies, 37,46 while the surgery involved both lymphoid tissue and tongue muscle resection at the surgeon's discretion in eight studies 16,18‐20,22,24,25,27,28,30,33‐35,38,41,43,44 . There were no information about the potential excision of tongue muscle in five studies 29,31,39,40,42 .…”

“…The majority of authors included patients with moderate to severe OSAS using various AHI thresholds 16,19,20,23,26‐33,35,36,39,41‐43,45‐47 . Three authors included patients with mild OSAS 21,22,44 .…”

“…The site of obstruction was determined through drug‐induced sleep endoscopy in 28 studies 16‐20,22‐28,30‐35,37‐46 …”