Radiofrequency of the lingual tonsil through a cervical approach

Abstract

Objectives: To explore the feasibility of a new approach to reduce lingual tonsil hypertrophy using radiofrequency in a patient with obstructive sleep apnea Methods: A 50-year-old patient who had had 3 consecutive procedures to treat upper airway disorders (UPPP, bimaxillary advancement, and radiofrequency tongue base reduction) still complained of daytime sleepiness. His respiratory disturbance index was 41 events per hour. His clinical examination showed major lingual tonsil hypertrophy. Radiofrequency of the lingual tonsils trough a cervical approach was performed with a sonographic and fluoroscopic control and under potentialized local anesthesia. A retractable 2 cm active electrode mounted on a 5 cm mandrel was introduced through the skin midway between the hyoid bone and the mandible in the midline. Eleven thousand joules were delivered in several points in the lingual tonsils Results: The patient did not complain of any pain during the procedure. He could eat within 4 hours. His tongue mobility remained normal. Nevertheless, the patient expressed pain for the 2 following weeks. There was no sign of clinical infection. A tomodensitometry showed oedema but no abscess. Five months after the procedure, the patient was no longer somnolent. The volume of the lingual tonsils decreased. His respiratory disturbance index was 8. Conclusion: Lingual tonsil radiofrequency is possible using a cervical approach under local anesthesia thus avoiding a possible difficult intubation. The fluoroscopy helped determine the position of the electrode in the sagittal and horizontal planes. Lingual tonsil hypertrophy can induce obstructive sleep apnea. By reducing the lingual tonsil volume, a patient could be cured.