Transoral Robotic Surgery (TORS) for the Management of Obstructive Sleep Apnea from Tongue Base Hypertrophy

Abstract

Objectives: Obstructive sleep apnea (OSA) is a medical problem that afflicts millions of Americans with considerable sequelae. The base of tongue is recognized as a significant site of obstruction leading to hypopharyngeal collapse during sleep. Many existing procedures implemented for the management of OSA typically have restricted surgical access to the base of tongue. However, transoral robotic surgery (TORS) provides excellent exposure to the tongue base and lingual tonsils. We aim to assess the success of robotically assisted partial glossectomy for tongue base reduction in patients with OSA. Methods: Medical records of patients ages >18 who underwent TORS for surgical management of OSA from 2011 through 2012 were retrospectively reviewed. Pre-operative and post-operative polysomnography were performed, and the results were compared to assess for improvement in OSA. Results: Twenty-one patients completed the pre- and post-operative evaluations. The mean apnea hypopnea index (AHI) decreased from 37.0 pre-operatively to 14.9 post-operatively, with a mean AHI reduction of 22.1 (p = <0.01). The mean oxygen saturation nadir was 79.2% pre-operatively and 83.3% post-operatively, with a mean increase in oxygen saturation nadir of 4.1% (p = 0.04). Conclusions: TORS provides excellent surgical access to the tongue base, allowing for improved base of tongue reduction for the management of OSA. In our patients who underwent robotically assisted partial glossectomy for OSA, there was a significant reduction in AHI, as well as a significant increase in oxygen saturation nadir.