Staging and Treating Snoring and Obstructive Sleep Apnea

The first time you do it, you’ll the effect on the retropalatal space is remarkable, Dr. Woodson said.

Dr. Steward described RF ablation treatments for OSA. The advantage of RF over surgery is that there is less morbidity, lower complication rates, less pain for the patient, does not require general anaesthesia, and it can be done as an outpatient procedure. The downside with RF ablation is that it requires multiple procedures and is less efficacious than nasal CPAP, he said.

He provided some tips for tongue base RF ablation. These included using a dilute local anesthetic that is buffered with sodium bicarbonate, treating the patient immediately after each injection, using a Peridex oral rinse and systemic antibiotics, not reusing handpieces, and targeting patients whose BMI is less than 34.

Tongue Suspension

Dr. Terris discussed the use of tongue suspension in hypopharyngeal sleep surgery. Before performing surgery for tongue base obstruction, a full assessment should include an upper airway examination, polysomnography, and a trial of CPAP; in addition, the physician must have informed consent from the patient, along with preoperative clearance.

The tongue suspension procedure (Repose) was originally designed for bladder suspension, but was adapted for use on the mandible. There have been early, promising results from a Stanford study on a total of 19 patients who also had concomitant UPPP, Dr. Terris said.

Indications for the procedure include moderate to severe OSA (AHI over 20); tongue base obstruction observed on a flexible airway examination; failure of CPAP (or refusal to use), and no medical contraindications to surgery.

One study showed a 60% success rate of tongue suspension plus UPPP. In some cases CPAP usage is still required, but can be tolerated at lower pressures, he said.

However, there are some caveats with the tongue suspension. Patients with microgenia or substantial enlargement of the tongue are not good candidates, and other surgical options should be shared with the patient, Dr. Terris said.

To avoid complications, Dr. Terris offered a few tips. One was to stay in the midline to avoid Wharton’s ducts. Right-handed surgeons should put the temporary suture loop on the right, and avoid making the suture too tight. Patients should be observed in the recovery room for a couple of hours to determine the level of care they may need.

©2007 The Triological Society