Tongue base suspension technique in obstructive sleep apnea: personal experience.
Tongue suspension with Kit Repose is a surgical mini-invasive end-oral technique used in treatment of rear tongue obstruction. The base of the tongue is anchored with a non-reabsorbable suture, held in place with a titanium screw, to the mandible in correspondence to the geni apophysis of the mandible: this loop should prevent the tongue, during sleep, from dropping backwards, favoured also by gravity and hypotonicity of the genioglossus muscle. Aim of this report is to focus on the results of our experience in 15 patients presenting obstructive sleep apnea submitted to uvulopalatopharyngoplasty associated with tongue suspension, using the Kit Response bone screw system (Influent Inc., San Francisco, CA, USA). Mean age of patients was 50.5 years (range 36-66), with mean RDI (apnoea/hypopnea index) of 44.47 (range 23-63) and mean body mass index of 28.27 (range 22.6-34.4). Scrupulous clinical evaluation, including endoscopy and cephalometry, revealed a pharyngeal obstruction both retro palatal and retro lingual. Clinical and polysonnographic examinations were carried out 4-6 months after surgery. Patients were considered responders if the RDI had decreased by 50% and below 20, with disappearance of subjective symptoms (snoring, daytime sleepiness). Polysonnographic examination showed, overall, good results with mean reduction of RDI from 44.5 to 24.2 (45% reduction); albeit, only 6 cases could be considered surgically successful; 4 cases (26.6%) showed improvement whereas the remaining 5 (33.4%) failed to present any significant change in RDI. Even if the technique was, indeed, mini-invasive, rapidly performed and lacked significant complications, the results were not, in our opinion, encouraging, bearing in mind the high cost of the kit and limited stability of the results over time. Better results can be obtained by advancement of the genioglossus associated with hyoid suspension, whereas, of the mini-invasive techniques, promising outcomes would appear feasible with reduction of volume at the base of the tongue, using radiofrequency.
Sorrenti
G
G
Department of Surgical Science and Reanimation, Otorhinolaryngology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Italy. gisorrenti@yahoo.it
Piccin
O
O
Latini
G
G
Scaramuzzino
G
G
Mondini
S
S
Rinaldi Ceroni
A
A
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019647:Oral Surgical Procedures / Q000379:methods*; D012008:Recurrence; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology* / Q000601:surgery*; D012913:Snoring / Q000453:epidemiology / Q000517:prevention & control; D014059:Tongue / Q000503:physiopathology* / Q000601:surgery*