Stuck Boris A., Maurer Joachim T., Hörmann Karl
Sleep Disorders Center, Department of Otorhinolaryngology, Head and Neck Surgery, University Clinic, Mannheim, Germany.
Sleep Breath. 2000;4(4):155-162. doi: 10.1007/s11325-000-0155-1.
Over the last few years, different surgical techniques for the treatment of obstructive sleep apnea syndrome have been developed. While new methods for the treatment of velopharyngeal obstruction turned out to be safe and effective, treatment of hypopharyngeal obstruction due to tongue base hypertrophy has remained, in many aspects, an unsolved problem. Surgical techniques for partial resection of the tongue base (midline glossectomy, lingualplasty) are effective but very invasive procedures requiring temporary tracheotomy, and have high postoperative morbidity. A maxillofacial approach showed significant reduction in the Respiratory Disturbance Index (RDI), especially when bimaxillar osteotomies are performed. Along with the concerns of postoperative morbidity, these techniques require general anesthesia and hospitalization. Tongue base reduction with temperature-controlled radiofrequency tissue ablation was introduced in 1998, and has proven to be a safe and simple procedure. Significant reduction in RDI has been shown in the majority of the treated patients. This procedure does not require general anesthesia and has low postoperative morbidity. For curative results, tongue base reduction with radiofrequency requires multiple treatment sessions. The goal of the present study is to investigate the beneficial effect of increased amount of energy applied per treatment session, reducing the number of treatment sessions per patient. By delivering increased amounts of energy, a similar cure and/or responder rate with 2 treatment sessions, rather than 5 to 6 as published in earlier studies, was accomplished. Postoperative morbidity was similar to previously published results although there was a slight increase in postoperative complications. Apart from the reduced number of treatment sessions needed per patient, we also demonstrated the beneficial effect of prophylactic use of antibiotics in our study group. This more aggressive treatment scheme appears to be well tolerated by the patients and may be an effective means of reducing the overall number of treatments.
