Combined bipolar radiofrequency surgery of the tongue base and uvulopalatopharyngoplasty for obstructive sleep apnea

Objective Plasma is formed by creating a high-density energy field within an electrically conductive fluid such as saline. Sometimes ablated bits of tissue get stuck between the electrodes of the wand, obstructing the suction channel. The purpose of this study is to investigate the effect of cooling the irrigating saline during ablation of the hypertrophied tongue base in patients with obstructive sleep apnea. Study Design Prospective randomized controlled trial. Setting An otorhinolaryngology department in Main University hospitals. Methods Sixty adult patients with obstructive sleep apnea and tongue base hypertrophy underwent tongue base ablation surgery. Patients were randomly divided into 2 groups of 30 patients each: cooled saline and room temperature saline. The Coblation wand used was the EVac 70 Xtra HP (Smith & Nephew). Results In this study, a significant difference in operative time (mean ± SD) was seen between groups: 21.2 ± 5.5 minutes in the cold group and 47 ± 9.5 minutes in the control group ( P = .001). The wands in the cold group did not obstruct, while all the wands in the control group were obstructed by tissue clogs with variable degrees, hence wasting more time to clean the wands’ tips. Conclusion Cooling the irrigating saline overcame the problem of wand clogs, and the wand tip did not occlude at all during the procedures, thus saving time lost in wand cleaning and demonstrating a faster and safer surgical procedure. Further studies are needed to identify the hemostatic effect of the cooled saline over the regular one.

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Gustatory Function after Radiofrequency Tongue Base Reduction in Patients with Obstructive Sleep Apnea

Otolaryngology ◽

10.1177/0194599811413680 ◽

2011 ◽

Vol 145 (5) ◽

pp. 853-857 ◽

Cited By ~ 4

Author(s):

Young Gyu Eun ◽

Seung Youp Shin ◽

Jae Yong Byun ◽

Myung Gu Kim ◽

Kun Hee Lee ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Surgical Treatment ◽

Sleep Apnea ◽

Medical Center ◽

Tongue Base ◽

Safe Procedure ◽

Gustatory Function ◽

Obstructive Sleep ◽

Before And After ◽

Tongue Base Reduction

Objectives. To investigate the changes in gustatory function as a complication after radiofrequency tongue base reduction (RTBR) in patients with obstructive sleep apnea (OSA). Study Design. Before-and-after study. Setting. Academic tertiary medical center. Subjects and Methods. Thirty-four patients with suspected velopharyngeal collapse only underwent uvulopalatopharyngoplasty (UPPP group). Twenty-five patients with velopharyngeal and retrolingual collapse underwent concurrent UPPP with RTBR (RTBR group). All patients were evaluated before surgery and at 1 and 4 weeks after surgical treatment. A questionnaire was given to assess symptoms of hypogeusia, dysgeusia, hyposmia, and sensation of the tongue. Electrogustometry (EGM) in 4 areas was used to determine gustatory function. Results. Postoperative values for subjective symptoms did not significantly change following surgical treatment in either group. EGM thresholds of all tested in both groups did not significantly change 1 week and 4 weeks after surgery. Conclusions. Gustatory function remained unchanged after RTBR in patients with OSA. The authors suggest that RTBR is a safe procedure in terms of taste sensation in OSA patients.

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Transoral robotic surgery of the tongue base for obstructive sleep apnea: Preliminary results

European Annals of Otorhinolaryngology Head and Neck Diseases ◽

10.1016/j.anorl.2018.09.001 ◽

2018 ◽

Vol 135 (6) ◽

pp. 411-415 ◽

Cited By ~ 1

Author(s):

G. de Bonnecaze ◽

B. Vairel ◽

A. Dupret-Bories ◽

E. Serrano ◽

S. Vergez

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Robotic Surgery ◽

Transoral Robotic Surgery ◽

Tongue Base ◽

Preliminary Results ◽

Obstructive Sleep

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Techniques for evaluation and management of tongue-base obstruction in pediatric obstructive sleep apnea

Current Opinion in Otolaryngology & Head & Neck Surgery ◽

10.1097/moo.0000000000000489 ◽

2018 ◽

Vol 26 (6) ◽

pp. 409-416 ◽

Cited By ~ 10

Author(s):

Stacey L. Ishman ◽

Katherine W. Chang ◽

Aimee A. Kennedy

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Tongue Base ◽

Obstructive Sleep

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Comparison of Findings between Clinical Examinations and Drug-Induced Sleep Endoscopy in Patients with Obstructive Sleep Apnea Syndrome

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17176041 ◽

2020 ◽

Vol 17 (17) ◽

pp. 6041

Author(s):

Huan-Yu Lin ◽

Yi-Chih Lin ◽

Ying-Shuo Hsu ◽

Liang-Chun Shih ◽

Tyler Nelson ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Sleep Apnea Syndrome ◽

Staging System ◽

Tongue Base ◽

Sleep Endoscopy ◽

Drug Induced ◽

Drug Induced Sleep Endoscopy ◽

Obstructive Sleep ◽

Physical Examinations

The Velum, Oropharynx, Tongue base and Epiglottis (VOTE) classification on drug-induced sleep endoscopy (DISE) is used widely for obstructive sleep apnea (OSA) syndrome, though research into comparative physical examinations with VOTE on DISE is still limited. The aim of this study was to evaluate the relationship between the findings of physical examinations and DISE in patients with OSA. Fifty-five patients with OSA were enrolled in this retrospective study. All of the patients received clinical explorations including a Brodsky classification, a modified Mallampati score (MMS), a modified Friedman’s staging system, and a Muller’s test. Drug-induced sleep endoscopy was further evaluated in the operating room. There were significant relationships between Brodsky classification, modified Friedman’s staging system, Muller’s test and oropharynx collapse during DISE (p < 0.05). Brodsky classification, MMS, modified Friedman’s staging system and retropalatal lateral-to-lateral (L–L) collapse of Muller’s test were significantly correlated with VOTE count (p < 0.05). The concordance between VOTE under DISE and Brodsky classification or modified Friedman’s staging system was moderate. In contrast, the concordance between VOTE under DISE and MMS or Muller’s test was slight. The study revealed that Brodsky classification and Friedman staging had a significant relationship with DISE on the velum and oropharynx, but the level of tongue base is uncertain between DISE and MMS. Correlation of awake evaluation of tongue base is still not correlated to the DISE findings. Pre-treatment evaluation of DISE is still warranted.

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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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Investigation of the Effectiveness of Surgical Treatment on Respiratory Functions in Patients With Obstructive Sleep Apnea Syndrome

Ear Nose & Throat Journal ◽

10.1177/0145561319840818 ◽

2019 ◽

Vol 99 (8) ◽

pp. 537-542

Author(s):

Burak Kersin ◽

Murat Karaman ◽

Engin Aynacı ◽

Ahmet Keleş

Keyword(s):

Obstructive Sleep Apnea ◽

Body Weight ◽

Surgical Treatment ◽

Sleep Apnea ◽

Obstructive Sleep Apnea Syndrome ◽

Respiratory Function ◽

Sleep Apnea Syndrome ◽

Tongue Base ◽

Obstructive Sleep ◽

Apnea Syndrome

Objective: Obstructive sleep apnea syndrome (OSAS) is a problem that involves many bodily systems and its effects on the respiratory system deserve special attention. Although many studies exist that investigate respiratory functions in patients using continuous positive airway pressure (CPAP) for the treatment of sleep apnea, there is a lack of research regarding the effect of OSAS surgery on respiratory function in the literature, which has motivated us to perform such a study. Materials and Methods: Thirty-two patients diagnosed with OSAS with an apnea hypopnea index ranging between 15 and 30 and had undergone robotic tongue base resection and uvulopharyngoplasty were included as study participants. Pulmonary function tests were performed on all participants 1 day prior to, and at 3 and 6 months after the operation. Weight and body mass indices (BMIs) were also recorded at the same intervals for all participants. Data were electronically recorded and analyzed through SPSS 22.0. Values of P < .05 have been considered as statistically significant. Results: Average age of the 32 participants was 43.2±10.7, average body weight was 94.1±12.6, and average BMI was 31.4±4.7. Decreases in body weight and BMI values recorded at 3 and 6 months postoperatively had statistical significance when compared with values recorded preoperatively ( P < .05). Comparisons made in terms of pulmonary functions revealed a statistically significant increase in 3 and 6-month postoperative values of FVC, FEV1, FEV1/FVC, PEF, and FEF 25-75 ( P < .05). Conclusion: Our study shows the positive effects of robotic tongue base resection and uvulopharyngoplasty operation on respiratory function parameters. This suggests that surgical treatment in OSAS patients is as effective as CPAP on respiratory function.

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