Woodson B T, Fujita S
Department of Otolaryngology and Human Communication, Medical College of Wisconsin, Milwaukee.
Otolaryngol Head Neck Surg. 1992 Jul;107(1):40-8. doi: 10.1177/019459989210700107.
Because uvulopalatopharyngoplasty (UPPP) as the sole procedure for severe obstructive sleep apnea syndrome (OSAS) is often inadequate, multiple other procedures have been developed. These have been directed at other sites of potential collapse of the upper airway. Initial experience with midline glossectomy (MLG) has shown direct modification of the tongue base to be an effective procedure in a subset of patients with OSAS. Lingualplasty, a modification of MLG, is demonstrated to provide an improved response rate. Twenty-two consecutive patients with severe OSAS and Fujita type II airway classification (retropalatal, oropharyngeal, and hypopharyngeal compromise) underwent lingualplasty. Fourteen patients had previously undergone unsuccessful UPPP. Eight had synchronous lingualplasty and UPPP. All were selected for lingualplasty because of obstructive tongue base anatomy. Responders were defined as having a respiratory disturbance index (RDI) of less than 20 events/hour. For the entire group, 17 of 22 (77%) were classified as responders, with RDI decreasing from 58.8 +/- 39.5 events/hour to 8.1 +/- 6.2 events/hour. Lingualplasty, as an isolated procedure, resulted in a 79% responder rate, with RDI decreasing from 50.2 events/hour to 8.6 events/hour. There were no significant changes in the RDI of the nonresponder groups. No differences were identified that discriminated responders from nonresponders, including age, body mass index, or cephalometry. There were six complications (27%), including bleeding (3), tongue edema (1), prolonged odynophagia (1), and subcutaneous emphysema related to tracheotomy (1). All resolved with treatment. These results indicate that in appropriately selected patients who do not respond to UPPP, lingualplasty is a significant improvement over MLG.
由于悬雍垂腭咽成形术（UPPP）作为治疗重度阻塞性睡眠呼吸暂停综合征（OSAS）的唯一手术方法往往并不充分，因此人们又开发了多种其他手术方法。这些手术针对上呼吸道其他可能塌陷的部位。中线舌切除术（MLG）的初步经验表明，直接改变舌根对于一部分OSAS患者是一种有效的手术方法。舌成形术是MLG的一种改良术式，已证明其有效率有所提高。22例连续的重度OSAS患者且气道分类为藤田II型（腭后、口咽和下咽均有阻塞）接受了舌成形术。14例患者此前接受UPPP手术未成功。8例患者同时进行了舌成形术和UPPP。所有患者均因舌根解剖结构阻塞而被选做舌成形术。反应者定义为呼吸紊乱指数（RDI）小于20次/小时。对于整个研究组，22例中有17例（77%）被归类为反应者，RDI从58.8±39.5次/小时降至8.1±6.2次/小时。舌成形术作为一种单独的手术，有效率为79%，RDI从50.2次/小时降至8.6次/小时。无反应组的RDI无显著变化。未发现能区分反应者与无反应者的差异，包括年龄、体重指数或头影测量。共有6例并发症（27%），包括出血（3例）、舌水肿（1例）、持续性吞咽痛（1例）以及与气管切开相关的皮下气肿（1例）。所有并发症经治疗后均得到缓解。这些结果表明，对于经选择的对UPPP无反应的患者，舌成形术相对于MLG有显著改善。
