Partial neurolysis of the hypoglossal nerve for selective lingual atrophy in a porcine model.
OBJECTIVE
Obstructive sleep apnea in children is most commonly treated with adenotonsillectomy; however, in cases of significant tongue base prolapse, this may prove inadequate. Surgical procedures used to increase the retroglossal airway have significant morbidities and low patient acceptability. We theorized that effective reduction of the tongue base can be achieved through partial denervation of the hypoglossal nerve, which is easily accessed in the submandibular space with minimal morbidity.


METHODS
We performed a prospective, experimental study in which topographic innervation maps of porcine tongue were generated by stimulating the hypoglossal main trunk and peripheral branches. The effects of complete unilateral nerve sectioning on tongue base volume and linear dimensions were measured and compared to the contralateral control side. In the final stage, only the peripheral nerve that was determined as the main supply to the tongue base was sectioned, and the results were compared to those in the matched controls.


RESULTS
A medial branch of the hypoglossal nerve was consistently identified as the main motor supply to the tongue base. Complete denervation resulted in a measurable decrease in the volume of the tongue base as compared to that of controls. Partial neurolysis produced inconsistent changes in 2 subjects, with decreases in linear dimensions that were not proportional to the decrease in volume. Histologically, complete denervation was followed by a significantly greater replacement of muscle with fat and connective tissue as compared with partial neurolysis.


CONCLUSIONS
There were inconsistent changes in volume and linear dimensions of the tongue base following partial neurolysis of the hypoglossal nerve over the 3-month experimental period.
Licup
Ana Teresa
AT
Department of Otolaryngology-Head and Neck Surgery University of Toronto, Toronto, Canada.
Arkia
Homan
H
Mabel
Anita
A
Cohen-Kerem
Raanan
R
Forte
Vito
V
D000818:Animals; D003714:Denervation / Q000379:methods*; D004195:Disease Models, Animal; D004576:Electromyography; D005260:Female; D005500:Follow-Up Studies; D007002:Hypoglossal Nerve / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D011446:Prospective Studies; D020181:Sleep Apnea, Obstructive / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D013552:Swine; D014059:Tongue / Q000294:innervation*; D014060:Tongue Diseases / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome