Hwang Chi Sang, Kim Jin Won, Park Sang Chul, Chung Hyo Jin, Kim Chang-Hoon, Yoon Joo-Heon, Cho Hyung-Ju
Department of Otorhinolaryngology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
The Airway Mucus Institute, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea.
Eur Arch Otorhinolaryngol. 2017 May;274(5):2197-2203. doi: 10.1007/s00405-017-4467-1. Epub 2017 Feb 21.
The base of the tongue has been recognized as a significant site of obstruction in patients with obstructive sleep apnea (OSA). Our aim was to determine the independent predictors of surgical success in tongue base resection combined with lateral pharyngoplasty for OSA. Thirty-one OSA patients who underwent endoscopie-guided coblator or transoral robotic tongue base resection in combination with lateral pharyngoplasty for the treatment of retroglossal obstruction between March 2012 and December 2015 were enrolled in this study. Retroglossal obstruction was identified by preoperative nasopharyngoscopy with drug-induced sleep endoscopy and/or Müller's maneuver in supine position. Patients were divided into success and failure groups according to surgical outcome (postoperative apnea-hypopnea index (AHI) less than 20 and reduction more than 50% in baseline AHI). Physical profile, polysomnography, cephalometry parameters, and drug-induced sleep endoscopy and/or Müller's maneuver findings were compared between the two groups. Tonsil grade (p = 0.002), lateral oropharyngeal wall collapse on Müller's maneuver (p = 0.002), and AHI during rapid eye movement (REM AHI) (p = 0.038) were significantly higher in the success group than in the failure group. Tongue base collapse was more evident in the failure group than in the success group when patients open their mouth. (p = 0.037) Bigger tonsil size and higher REM AHI are favorable predictive factors, even in multilevel surgery such as tongue base resection, whereas tongue base collapse during mouth opening may be an unfavorable predictive factor.
舌根已被认为是阻塞性睡眠呼吸暂停（OSA）患者的一个重要阻塞部位。我们的目的是确定舌根切除术联合咽外侧成形术治疗OSA手术成功的独立预测因素。本研究纳入了2012年3月至2015年12月期间接受内镜引导下等离子刀或经口机器人舌根切除术联合咽外侧成形术治疗舌后阻塞的31例OSA患者。通过术前鼻咽镜检查、药物诱导睡眠内镜检查和/或仰卧位米勒动作来确定舌后阻塞。根据手术结果（术后呼吸暂停低通气指数（AHI）小于20且基线AHI降低超过50%）将患者分为成功组和失败组。比较两组患者的身体特征、多导睡眠图、头影测量参数以及药物诱导睡眠内镜检查和/或米勒动作的结果。成功组的扁桃体分级（p = 0.002）、米勒动作时咽侧壁塌陷（p = 0.002）以及快速眼动期AHI（REM AHI）（p = 0.038）均显著高于失败组。患者张口时，失败组的舌根塌陷比成功组更明显（p = 0.037）。较大的扁桃体大小和较高的REM AHI是有利的预测因素，即使在诸如舌根切除术这样的多平面手术中也是如此，而张口时舌根塌陷可能是一个不利的预测因素。
