What effect does transoral robotic surgery (TORS) base of tongue (BOT) reduction have on sleep-related outcomes in patients with obstructive sleep apnea (OSA)?
Bottom line: TORS BOT reduction decreases AHI and symptoms of sleepiness in adult patients with OSA. It is considered successful in a majority of cases, but further studies must be performed to optimize patient selection criteria to achieve higher rates of success.
Explore this issue:January 2017
Background: The first-line treatment for moderate-to-severe OSA is continuous positive airway pressure (CPAP). Despite the important CPAP benefits, adherence rates range from 50% to 70%. Surgery of the tongue base remains challenging due to difficult surgical access and visualization along with uncertainty with regard to the volume of tissue that can be safely excised.
Study design: Retrospective literature review of six articles with 353 patients treated with TORS BOT reduction.
Setting: PubMed, Scopus, EMBASE, CINAHL, Cochrane, and Ovid databases.
Synopsis: The primary outcomes of interest were postoperative changes in AHI, lowest oxygen saturation (LSAT), Epworth Sleepiness Scale (ESS), and snoring visual analog scale (VAS) as well as surgical success (reduction of AHI > 50% and postoperative AHI < 20) and cure (postoperative AHI < 5). All six studies included TORS BOT reduction as part of multilevel surgery, with a small minority of patients undergoing TORS BOT reduction alone.
Comparison of means revealed statistically significant changes in mean reduction in AHI of 44.3 ± 22.4 to 17.8 ± 16.5; mean LSAT increase from 79.0 ± 9.5 to 84.1 ± 6.5; mean ESS reduction from 12.9 ± 5.4 to 5.8 ± 3.7; and VAS reduction from 9.3 ± 0.8 to 2.4 ± 2.4. Five studies demonstrated surgical success in 68.4% of 314 patients. Surgical cure was seen in 23.8% of 287 patients in four studies. Five articles reported adverse events; the most common were taste alteration, tongue numbness, tongue soreness, bleeding, edema, and dysphagia. Limitations included a lack of prospective, randomized trials, potential selection bias, heterogeneity across included studies, and a wide variation of reporting complications.
Citation: Miller SC, Nguyen SA, Ong AA, Gillespie MB. Transoral robotic base of tongue reduction for obstructive sleep apnea: a systematic review and meta-analysis. Laryngoscope. 2017;127:258–265.