Hsin Li-Jen, Lee Yi-Chan, Lin Wan-Ni, Lu Yi-An, Lee Li-Ang, Tsai Ming-Shao, Cheng Wen-Nuan, Chiang Yen-Ting, Li Hsueh-Yu
Departments of Otolaryngology-Head & Neck Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan 33305, Taiwan.
College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
J Clin Med. 2022 Aug 24;11(17):4960. doi: 10.3390/jcm11174960.
Objectives: To evaluate the safety and efficacy of a novel technique for transoral tongue suspension (TOTS) in obstructive sleep apnea (OSA) patients. Material and Methods: The retrospective study enrolled 24 consecutive OSA patients (21 males; average age, 43 years; average apnea−hypopnea index (AHI), 42.2 event/h; average body mass index (BMI), 25.7 kg/m2) with tongue obstruction confirmed by drug-induced sleep endoscopy. All patients received TOTS as the main procedure in conjunction with uvulopalatopharyngoplasty (UPPP). Key procedures of TOTS included a transoral sublabial approach, drilling two holes on the mandible, passing the polypropylene through the hole to the tongue base using a suture passer and returning the polypropylene through loop traction, and tying the polypropylene to the mandible. Lingual tonsil ablation (n = 8) was also implemented in hypertrophic lingual tonsils (grades III and IV). Results: The operation time for TOTS was around 30 min. No wound bleeding or airway compromise occurred throughout the postoperative period. Minor complications were temporary and included swelling of the tongue, numbness of the lower incisor, and sublabial wound dehiscence (n = 2). The quality of life improved significantly in the patients’ subjective daytime sleepiness according to the Epworth Sleepiness Scale (11.4 ± 3.2 vs. 5.7 ± 1.6, p < 0.001). The objective parameters of OSA also improved significantly in the apnea/hypopnea index (42.2 ± 21.8 vs. 19.5 ± 16.2, p < 0.001), minimal oxygen saturation (77.1 ± 12.2 vs. 81.7 ± 8.1, p = 0.026), and snoring index (207 ± 141 vs. 101 ± 91, p = 0.03). Conclusions: The demonstrated TOTS showed its advantage in low morbidity with a scarless exterior and easy performance with free availability in treating adult OSA patients with tongue obstruction. TOTS combined with UPPP significantly improved AHI and daytime sleepiness. TOTS can be implemented with lingual tonsillectomy to achieve both stabilization of the tongue and widening of hypopharyngeal airway.
评估一种新型经口舌悬吊术（TOTS）治疗阻塞性睡眠呼吸暂停（OSA）患者的安全性和有效性。材料与方法：这项回顾性研究纳入了24例连续的OSA患者（21例男性；平均年龄43岁；平均呼吸暂停低通气指数（AHI）为42.2次/小时；平均体重指数（BMI）为25.7kg/m²），这些患者经药物诱导睡眠内镜检查证实存在舌阻塞。所有患者均接受TOTS作为主要手术，并联合悬雍垂腭咽成形术（UPPP）。TOTS的关键步骤包括经口唇下入路，在下颌骨上钻两个孔，使用缝线推送器将聚丙烯线穿过孔至舌根，然后通过环扎牵引将聚丙烯线返回，并将聚丙烯线系在下颌骨上。对于肥大的舌扁桃体（III级和IV级）还实施了舌扁桃体消融术（n = 8）。结果：TOTS的手术时间约为30分钟。术后整个期间未发生伤口出血或气道梗阻。轻微并发症为暂时性，包括舌肿胀、下切牙麻木和唇下伤口裂开（n = 2）。根据Epworth嗜睡量表，患者主观日间嗜睡的生活质量显著改善（11.4±3.2 vs. 5.7±1.6，p < 0.001）。OSA的客观参数在呼吸暂停/低通气指数（42.2±21.8 vs. 19.5±16.2，p < 0.001）、最低氧饱和度（77.1±12.2 vs. 81.7±8.1，p = 0.026）和打鼾指数（207±141 vs. 101±91，p = 0.03）方面也显著改善。结论：所展示的TOTS在治疗成人舌阻塞性OSA患者中显示出低发病率、无外部瘢痕且操作简便、易于实施的优势。TOTS联合UPPP显著改善了AHI和日间嗜睡。TOTS可与舌扁桃体切除术联合实施，以实现舌的稳定和下咽气道的拓宽。
