Evaluation of open midline glossectomy in the multilevel surgical management of obstructive sleep apnea syndrome.
OBJECTIVE
To analyze the overall success rate of open midline glossectomy with lingual tonsillectomy in the surgical management of obstructive sleep apnea syndrome (OSAS) as well as a subset analysis to determine whether certain patient factors influence clinical outcome.


METHODS
Case series with retrospective data collection.


METHODS
Private practice with surgeries performed at a single community hospital (St Johns-Riverside Hospital).


METHODS
Fifty consecutive patients who had moderate to severe OSAS with Friedman tongue position III or IV and underwent midline glossectomy with lingual tonsillectomy as part of multilevel sleep apnea surgery and had pre- and postsurgery in-laboratory sleep studies performed.


RESULTS
The overall success rate was 56.0% using success defined as a postoperative apnea-hypopnea index (AHI) less than 20 and a decrease of greater than 50%. Median AHI decreased from 52.0 to 18.3 with a median change of -26.1 (interquartile range, -41.6 and -17.1). Of significance on subset analysis, patients with a preoperative AHI <60 had a 68.8% success rate (P = .02), and patients with Friedman tongue position III had a 75.9% success rate (P = .0009).


CONCLUSIONS
The findings of this case series would suggest that multilevel sleep apnea surgery, incorporating midline glossectomy with lingual tonsillectomy, is a valid alternative for managing moderate to severe OSAS in patients who do not respond or are resistant to continuous positive airway pressure therapy. In patients with a preoperative AHI <60 or Friedman tongue position III, surgical success rate is significantly improved.
Section of Otolaryngology, St Johns-Riverside Hospital, Yonkers, New York, USA. gsuh@entandallergy.com
Gerald D
GD
Suh
D000328:Adult; D000368:Aged; D017115:Catheter Ablation / Q000379:methods*; D015331:Cohort Studies; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005927:Glossectomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014066:Palatine Tonsil / Q000601:surgery*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D017286:Polysomnography / Q000379:methods; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000601:surgery*; D014059:Tongue; D014068:Tonsillectomy / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult