Simultaneous Tongue Base Somnoplasty in Obstructive Sleep Apnea Surgery

Lionel M Nelson MD (Presenter)
San Jose, CA

Objective: Obstructive sleep apnea syndrome (OSAS) is frequently associated with upper airway obstruction at multiple levels. The best method to treat a retroglossal level remains controversial, and until recently, available procedures involved invasive surgery, which many patients and surgeons were reluctant to undertake. Temperature-controlled radiofrequency tongue base reduction (Somnoplasty) may be a less morbid alternative. Although tongue base Somnoplasty has been evaluated as a separate procedure, it has not been formally tested as an initial combined component of site-directed multilevel OSA surgery. This study is designed to investigate the safety, feasibility, and efficacy of using simultaneous tongue base Somnoplasty with other multilevel operative procedures for OSAS

Methods: This was a prospective, nonrandomized study of 10 OSAS patients with multilevel obstruction based on physical examination with supine pharyngoscopy, cephalometrics, and acoustic reflection. All patient underwent simultaneous uvulopalatopharyngoplasty (UPPP), nasal septoplasty/turbinate reduction when indicated, and tongue base Somnoplasty under general anesthesia. Two additional tongue base Somnoplasties under local anesthesia followed in-office, bringing the total tongue base radiofrequency energy delivered to 12,000 J. Perioperative morbidity was compared to that of a control group undergoing nasal correction and UPPP without tongue base Somnoplasty. Follow-up examination and questionnaire regarding treatment morbidity and OSA symptoms were conducted at 1, 3, and 7 days, and 1, 2, and 6 months, including repeat sleep studies at 2 months.

Results: At the time of this abstract submission, 4 patients have been assessed at 2 months. There is an average apnea-hypopnea index reduction of 54% to 17.3/hour and minimum oxygen saturation increase from 79% to 87%. The Epworth score went from an average of 11.25 to 5.25, daytime sleepiness from 5.5 to 1.8 and snoring from 8.1 to 1.3. Acoustic reflection showed obstructions (<2 cm_ at specific airway level) decreased from 4 to 1 at the palate and from 4 to 0 at the tongue base. There were no operative complications, and perioperative pain and dysphagia were similar to those of the control group. Data on the additional study patients and follow-up to 6-months will be presented.

Conclusion: Tongue base Somnoplasty performed simultaneously with UPPP and septoplasty/turbinate reduction is both safe and feasible in planned multilevel OSA surgery. It appears to effectively reduced the retroglossal obstructive component in selected patients.