Lu Yi-An, Wang Chao-Jan, Chiang Yen-Ting, Li Hsueh-Yu
Department of Otolaryngology Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan.
School of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
J Clin Med. 2022 Jul 19;11(14):4186. doi: 10.3390/jcm11144186.
Obstruction of the tongue is commonly seen in patients with obstructive sleep apnea (OSA). This study proposed whole tongue treatment using coblation ablation tongue (CAT) and aimed to explore the potential association between the dimensions of a tongue and the severity of OSA, to inspect volumetric changes of the tongue after CAT, and to search for factors that influence outcome of tongue volume change.
The prospective study enrolled 12 OSA patients (all male, average age: 35 years, average apnea/hypopnea index (AHI): 45.5 event/h, average body mass index (BMI): 27.0 kg/m). All patients received multi-level sleep surgery including septomeatoplasty, uvulopalatopharyngoplasty, and CAT. The CAT used a coblation wand to perform uniform multiple ablations (15 points, body -6, base -9) on dorsal tongue. Three dimensions of the tongue (length, height, and width) and tongue volume were measured from head and neck computed tomography. The perioperative changes in the tongue dimension/volume and AHI were assessed at baseline and 3 months after surgery.
The baseline tongue length and AHI had a significant correlation (r = 0.60, = 0.02). The multi-level surgery significantly improved AHI (43.8 vs. 23.7, = 0.008). The CAT significantly decreased tongue volume from 91.3 to 85.6 cm ( = 0.02), with an average tongue volume reduction of 5.7 cm per person and 0.38 cm per ablation. Further outcome analysis showed surgical success was significantly higher in patients with non-hypertrophic lingual tonsils (grade I/II) than in those with hypertrophic lingual tonsils (grade III/IV) ( = 0.02).
Length of the tongue is associated with the severity of OSA. The CAT significantly decreased the tongue volume in OSA patients. A volumetric reduction of 0.38 cm per ablation could be useful in the optimal reduction of tongue for OSA. The CAT significantly enlarged the retroglossal airway volume, which is related to the non-hypertrophic lingual tonsil.
舌阻塞在阻塞性睡眠呼吸暂停（OSA）患者中较为常见。本研究提出使用低温等离子体消融舌部（CAT）进行全舌治疗，旨在探讨舌的尺寸与OSA严重程度之间的潜在关联，观察CAT术后舌的体积变化，并寻找影响舌体积变化结果的因素。
这项前瞻性研究纳入了12例OSA患者（均为男性，平均年龄：35岁，平均呼吸暂停/低通气指数（AHI）：45.5次/小时，平均体重指数（BMI）：27.0kg/m²）。所有患者均接受了包括鼻中隔成形术、悬雍垂腭咽成形术和CAT在内的多水平睡眠手术。CAT使用低温等离子体刀头在舌背进行均匀的多次消融（15个点，舌体部-6个点，舌根部-9个点）。通过头颈部计算机断层扫描测量舌的三个维度（长度、高度和宽度）以及舌体积。在基线和术后3个月评估舌维度/体积和AHI的围手术期变化。
基线时舌长度与AHI存在显著相关性（r = 0.60，P = 0.02）。多水平手术显著改善了AHI（43.8对23.7，P = 0.008）。CAT使舌体积从91.3cm³显著降至85.6cm³（P = 0.02），平均每人舌体积减少5.7cm³，每次消融减少0.38cm³。进一步的结果分析显示，非肥厚性舌扁桃体（I/II级）患者的手术成功率显著高于肥厚性舌扁桃体（III/IV级）患者（P = 0.02）。
舌的长度与OSA的严重程度相关。CAT显著降低了OSA患者的舌体积。每次消融0.38cm³的体积减少可能有助于OSA患者舌体积的最佳减少。CAT显著扩大了舌后气道体积，这与非肥厚性舌扁桃体有关。
