Robot-assisted Tongue Base Resection ensures favorable therapeutic outcome to Obstructive Sleep Apnea patients with Lingual tonsil hypertrophy

Sung-Woo Cho,Seung-No Hong,Dong-Young Kim,Tae-Bin Won,Doo Hee Han,Hyun Jik Kim

doi:10.1038/s41598-018-36800-7

Abstract

Tongue base (TB) narrowing is recognized as a significant site of upper airway collapse during sleep in obstructive sleep apnea (OSA) patients and robot technology is expected to have promising clinical utility in OSA patients with TB narrowing. The purpose of our study is to demonstrate the better therapeutic conditions and favorable indications of robot-assisted TB resection (TBR) in OSA. We performed robot-assisted TBR combined with nasal and palatal surgery in 16 OSA patients with any of the following characteristics: severe TB narrowing (over grade II) and moderate or severe OSA. The preoperative median AHI was 48.8/hr and the median lowest SaO2 was 82.0%. The median AHI decreased to 18.7/hr and ten patients (62.5%) were included in the responder group following robot-assisted TBR combined with nasal and palatal surgery. The lowest SaO2 improved to 90.5% and the posterior airway space (PAS) was significantly increased following robot-assisted TBR. Cephalometric results showed that wider PAS were observed in responders compared to non-responders prior to robot-assisted TBR. Interestingly, there was greater improvement in the objective parameters including PAS in the OSA patients with lingual tonsilar hypertrophy than they were in those without and all patients with lingual tonsillar hypertrophy (n = 6) responded to robot-assisted TBR. Robot-assisted TBR exhibited minimal morbidity and postoperative complications in OSA patients. Robot-assisted TBR can be considered a promising and innovative surgical option to reduce TB volume and improve sleep parameters in OSA patients with TB narrowing. OSA patient with TB narrowing due to lingual tonsil hypertrophy shows greater therapeutic outcome and lingual tonsil hypertrophy appears to be most favorable surgical indications of robot-assisted TBR.

Highlights

obstructive sleep apnea (OSA) is characterized a fixed or dynamic upper airway obstruction and this obstruction is either caused by anatomical factors or abnormal upper airway motor tone
16 subjects previously diagnosed with OSA and performed robot-assisted tongue base resection (TBR) combined with septoturbinoplasty and palatal surgery to resolve upper airway narrowing
We found that robot-assisted TBR could be an adequate surgical option to improve upper airway narrowing at the retroglossal level in moderate to severe OSA

Summary

Introduction

OSA is characterized a fixed or dynamic upper airway obstruction and this obstruction is either caused by anatomical factors or abnormal upper airway motor tone. There is need for more complete control of TB narrowing in order to improve the therapeutic outcomes of OSA surgery and we need to drive more interest in improving surgical techniques for reduction of tongue base volume. According to recent published data, there are several minimally invasive transoral techniques that have been introduced for volume reduction of TB in OSA patients Some of these new techniques include radiofrequency ablation, laser-assisted oropharyngeal surgery, and coblation endoscopic lingual lightening[16,17,18] and robot technology has been successfully applied in correction of TB narrowing of OSA patients. We sought to determine the therapeutic outcomes of robot-assisted TBR combined with nasal and palatal surgeries in patients with moderate or severe OSA. We investigated the favorable surgical indications for robot-assisted TBR using sleep parameters, drug-induced sleep endoscopic (DISE) findings, or cephalographic findings

Objectives

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Results

Conclusion