title: Minimally invasive tongue base surgery for obstructive sleep apnoea.
abstract: Moderate to severe obstructive sleep apnoea is usually associated with multiple levels of pharyngeal airway collapse, including tongue base obstruction. A new technique has recently been introduced that improves the nocturnal retro-lingual airway. This study was a prospective, non-randomized single-institution evaluation of a recently introduced surgical technique. Nineteen consecutive patients with previously untreated moderate to severe obstructive sleep apnoea underwent tongue suspension using the Respose system and concomitant palatopharyngoplasty (multilevel pharyngeal surgery). The patient demographics and treatment outcomes were prospectively collected and retrospectively analysed. There were 16 men and three women, with a mean (+/-SD) age of 44.9 years (+/- 14.2) and a mean pre-operative apnoea-hypopnoea index (AHI) of 42.8 +/- 24.8. Twelve of the 19 patients (63.2 per cent) have had post-operative polysomnography; eight of these 12 (67 per cent) met the standard criteria for surgical response. Among these eight patients, the AHI improved from 32.4 to 14.4 (p<0.01); the individual scores fell by a mean of 51.7 per cent. The apnoea index improved from 7.4 to 0.9 (p<0.01), with the individual scores falling by a mean of 81.4 per cent. There was anatomic and radiographic evidence of multilevel upper airway enlargement. Notably, the body mass index remained essentially unchanged (31.5 +/- 7.2 to 31.2 +/- 7.6, p>0.5). Subjectively, the mean Epworth sleepiness scale score fell from 11.0 +/- 5.4 to 5.4 +/- 3.8 (p<0.005). Four patients suffered transient velopharyngeal insufficiency, and two patients complained of limited anterior excursion of the tongue. There were no serious, long-term complications. The tongue suspension procedure represents a minimally invasive technique for improving the nocturnal retro-lingual airway in patients with obstructive sleep apnoea. It is easily performed by otolaryngologists, distinguishing it from other established techniques designed to address tongue base obstruction.
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, Medical College of Georgia, Augusta 30812-4060, USA. dterris@mcg.edu
authors.forename: David J
authors.initials: DJ
authors.lastname: Terris
authors.forename: Larisa D
authors.initials: LD
authors.lastname: Kunda
authors.forename: Marie C
authors.initials: MC
authors.lastname: Gonella
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009059:Mouth Diseases / Q000601:surgery*; D017286:Polysomnography / Q000379:methods; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D013525:Surgical Instruments; D014059:Tongue / Q000601:surgery*; D017211:Treatment Failure