How Does the Anatomy of the Lingual Artery Limit Base of Tongue Reduction for Obstructive Sleep Apnea? A Retrospective Review of a Large Cohort Using CT Angiograms of the Neck

Objective: To clarify the differences in assessing the course of the lingual artery between lingual artery computed tomography angiography (CTA) and ultrasound (US). Methods: Twenty-six OSA patients were included in this study and accomplished lingual artery CTA and US, respectively. The differences in the depths of the lingual arteries and the distances between the bilateral lingual arteries on 3 measurement levels based on lingual artery CTA and US were compared. Results: The depths of the lingual arteries on 3 measurement levels by CTA were deeper than those by US ( P < .01). There was no significant difference in the distances between bilateral lingual arteries on 3 measurement levels between CTA and US ( P > .05). Conclusions: The parameters of lingual artery measured by lingual artery US were similar to or smaller than those measured by lingual artery CTA. Like lingual artery CTA, lingual artery US could be used as an effective method to ensure the safety of the operation.

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0659 A Safe and Precise Tongue Base Surgery for Obstructive Sleep Apnea: Real-Time Intraoperative Ultrasound-Assisted Transoral Robotic Surgery

SLEEP ◽

10.1093/sleep/zsaa056.655 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A251-A252

Author(s):

C Lin ◽

C Chang ◽

J Hsiao ◽

J Wu ◽

H Tsai

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Robotic Surgery ◽

Intraoperative Ultrasound ◽

Transoral Robotic Surgery ◽

Tongue Base ◽

Assessment Tools ◽

Bleeding Complications ◽

Lingual Artery ◽

Obstructive Sleep

Abstract Introduction Lingual artery (LA) injury is a devastating complication of tongue base surgery. Compared with the anatomic findings of computed tomography angiography (CTA), intraoperative blade of mouth gag might change the thickness of base of tongue (BOT) and anatomy of LA. We aimed to investigate the position of LA in the BOT with intraoperative ultrasound (IOU) imaging during transoral robotic surgery (TORS), and evaluate the bleeding complications when assisted with / without IOU. Methods Adult obstructive sleep apnea (OSA) patients who received TORS in BOT resection were recruited since 2016. Assessment tools were pre-op over-night hospital polysomnography (PSG) and anatomy-based Friedman Staging System. Ultrasound imaging was utilized to identify anatomic parameters of LA in BOT, including distance to midline, arterial depth and diameter. Results Ninety-three OSA patients (82 male, 88.2%) were analyzed. The mean age was 42.2±10.0 years old and body mass index was 29.2±4.5 kg/m2. The average apnea hypopnea index (AHI) was 58.1±21.4 events/hour. There were 66 (71.0%), 24 (25.8%) and 3 (3.2%) patients in Friedman stages II, III and IV, respectively. Seventy patients underwent TORS with IOU had shorter operation time (191.7±3.8 minutes) than 23 patients without IOU (220.1±6.6 minutes), less total blood loss (11.3±10.8 versus 19.6±26.7 ml), and more BOT tissue reduction volume (7.1±2.5 versus 3.9±1.6 ml). Significant predictors of arterial depth were higher AHI level during rapid-eye-movement (REM) sleep stage (p=0.038), bigger tonsil size (p=0.034) and more elevated Friedman tongue position (p=0.012). Postoperative complication associated with LA injury was not found in the patients with use of IOU. Conclusion When tongue retracted with blade, the distance to midline and depth of LA were altered in BOT. With IOU assisted, surgeon could identify LA position confidently. It is expectable to maximize efficiency and minimize catastrophic bleeding complications when OSA patients received TORS in BOT resection. Support nil

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Volumetric Tongue Reduction for Obstructive Sleep Apnea

Sleep Medicine Clinics ◽

10.1016/j.jsmc.2018.10.007 ◽

2019 ◽

Vol 14 (1) ◽

pp. 59-65 ◽

Cited By ~ 2

Author(s):

Hsin-Ching Lin ◽

Michael Friedman

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Obstructive Sleep ◽

Tongue Reduction

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Marked Improvement in Nocturnal Gastroesophageal Reflux in a Large Cohort of Patients With Obstructive Sleep Apnea Treated With Continuous Positive Airway Pressure

Archives of Internal Medicine ◽

10.1001/archinte.163.1.41 ◽

2003 ◽

Vol 163 (1) ◽

pp. 41 ◽

Cited By ~ 124

Author(s):

Bryan T. Green ◽

William A. Broughton ◽

J. Barry O'Connor

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Continuous Positive Airway Pressure ◽

Gastroesophageal Reflux ◽

Airway Pressure ◽

Marked Improvement ◽

Positive Airway Pressure ◽

Large Cohort ◽

Obstructive Sleep

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R462 – Anatomic Characteristics of Tongue Coblation

Otolaryngology ◽

10.1016/j.otohns.2008.05.622 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P199-P200

Author(s):

Liu Delong ◽

Liu Qingfeng ◽

Qin Wenfei

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Hypoglossal Nerve ◽

Sleep Apnea Syndrome ◽

Lingual Artery ◽

Horizontal Distance ◽

Human Tongue ◽

Vertical Distance ◽

Obstructive Sleep ◽

Human Cadavers

Problem We investigated the topographic anatomic characteristics of the human tongue in order to determine the safest location for Coblation® (ArthroCare Corp., Sunnyvale, CA) tongue treatment in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and to provide detailed anatomic data to facilitate the surgery. Methods We dissected 16 lateral tongues from human cadavers and studied the distribution of the hypoglossal nerve and lingual artery and their respective distances. The ratios of those distances to the length and width of the tongue were calculated to establish the safest locations for Coblation tongue treatment. Results The vertical distance from the hypoglossal nerve and lingual artery to the surface of the tongue was invariant near the foramen caecum. The ratio of the horizontal distance from the hypoglossal nerve and lingual artery to the midline of the tongue to its length and the vertical distance to the surface at the foramen caecum and at 10 mm and 25 mm from the apex was obtained. Analysis of the data using ANOVA (analysis of variance) revealed statistically significant differences (p<0.05). Conclusion Low-temperature radiofrequency tongue treatment (Coblation) offers a safe and effective treatment for patients with retroglossal OSAHS. Recognizing the topographic anatomic characteristics of the tongue and applying the concepts of ratio and individualization, in which consideration is given to each patient's unique anatomy, promotes greater safety and optimal patient outcomes. Significance The data could extend the area of surgery in tongue from before or after caecum to the whole tongue. It could facilitate the coblation tongue treatment which is different from those surgeries in the base of tongue. And coblation tongue channeling (CTC) is very useful to treat hypertrophic tongue in obstructive sleep apnea syndrome (OSAS). We have performed many CTC on the patients with OSAS and give the relative area by proportional view in the tongue based on the data.

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