Lingual Tonsil Hypertrophy Research Articles

Complete upper airway obstruction after induction of anesthesia in a child with undiagnosed lingual tonsil hypertrophy

We present a case of a 9-year-old patient with previously undiagnosed lingual tonsil hypertrophy (LTH) that caused sudden and complete airway obstruction and inability to ventilate on induction of anesthesia. More frequently described in adults than in children, LTH can complicate mask ventilation, intubation or both, with the potential for catastrophic consequences.

Lingual tonsillectomy

Lingual tonsil hypertrophy can result in obstructive sleep apnea, chronic infection, and, rarely, dysphagia. In patients with severe symptoms who do not respond to medical therapy, removal of lingual tonsils can be helpful. This procedure is best performed through the mouth using a Lindholm laryngoscope for exposure of the tongue base. The lingual tonsils are then ablated with the use of a CO2 laser with a flash scanner. A suction debrider may also be used to remove the lingual tonsils. Patient evaluation, technique, as well as risks and benefits of the procedure are presented. Lingual tonsil hypertrophy can result in obstructive sleep apnea, chronic infection, and, rarely, dysphagia. In patients with severe symptoms who do not respond to medical therapy, removal of lingual tonsils can be helpful. This procedure is best performed through the mouth using a Lindholm laryngoscope for exposure of the tongue base. The lingual tonsils are then ablated with the use of a CO2 laser with a flash scanner. A suction debrider may also be used to remove the lingual tonsils. Patient evaluation, technique, as well as risks and benefits of the procedure are presented.

Radiofrequency of the lingual tonsil through a cervical approach

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.

Obstrucción respiratoria secundaria a hipertrofia de la amígdala lingual: Casos clínicos

The lingual tonsil is a normal structure that only occasionally produces respiratory symptoms. In the paedriatric literature there are few reports referring to this subject. The article’s objective was to review the clinical and laboratory presentation of patients with lingual tonsil hypertrophy. A retrospective study, using case notes, of 5 cases with a flexible bronchoscopy confirmed diagnosis of lingual tonsil hypertrophy was carried out. Past medical history, symptoms, x-ray and lung function studies were analyzed. The age range was 8-14 years. In 2 cases the symptomology presented as recurrent laryngitis at an unusual age (8 and 13 years). One was described as an asthmatic with an inspiratory obstructive component and 2 others had abnormal spirometric findings in their studies for asthma. All patients had an abnormal flow/volume curve suggesting upper airway obstruction. 3 cases had normal x-rays (lateral neck and chest). In 2 cases surgery was indicated but only 1 performed, the other 3 were followed up because they had few symptoms. In summary lingual tonsil is not a common pathology but should be considered in cases of inspiratory obstruction at an unusual age or if the flow/volume curve shows a decreased inspiratory loop.

Patient selection and surgical results in obstructive sleep apnea.

In recent years, therapeutic methods have been effective in the management of snoring and sleep apnea. Successful results have been possible through conservative and surgical approaches when the nature and site of obstruction is ascertained by careful investigation. Sagittal magnetic resonance imaging (MRI) of the upper respiratory tract has been the most valuable diagnostic tool in patients with obstructive sleep apnea. This has made it possible to measure the dimensions and distance of the hard and soft palate and tongue base to the posterior pharyngeal wall. Surgery is only indicated when a site of obstruction can be completely determined. In this study, surgical approaches and results obtained in 50 patients after surgery for sleep apnea are presented. Uvulopalatopharyngoplasty (UPPP) had a higher success rate in patients with obstruction at the level of the soft palate, but this rate decreased when it was associated with hypopharyngeal obstruction or when there was hypopharyngeal obstruction alone. UPPP was found to be beneficial in patients with central apnea. Nasal pathologies also played an important role in sleep apnea. Better results were obtained when UPPP was performed in patients who were young, not obese and an apnea-hypopnea index was below 40. Some unusual pathologies included lingual tonsil hypertrophy in the adult, sublingual dermoid cysts and angioma of soft palate and were found to be the cause of OSA. After surgical excision of these pathologies, apneic periods disappeared.

The efficacy of laser-assisteduvulopalatoplasty in the management of obstructive sleep apnea and upper airway resistance syndrome

Laser-assisted uvulopalatoplasty (LAUP) is an effective method for treating patients experiencing loud habitual snoring. LAUP is reserved for patients with either simple snoring or mild sleep apnea. The procedure is performed in several stages in an ambulatory setting under local anesthesia using a CO₂ laser with a special handpiece. One major advantage of LAUP over uvulopalatopharyngoplasty (UPPP) is the ability to titrate tissue removal without the risk of overresection. We have achieved an 85% success rate for reduction or elimination of snoring in over 450 patients. Of our patients evaluated for snoring, 71% had polysomnography before surgical treatment. Various degrees of obstructive sleep apnea syndrome (OSAS) were found in most of these patients. The initial treatment of choice for moderate to severe OSAS is continuous positive airway pressure (CPAP). CPAP and weight control in conjunction with extended LAUP is the recommended long-term management. The primary reason for lack of response to LAUP in the management of OSAS is usually lingual tonsil hypertrophy. Laser surgery directed to the tongue base may be the preferred method of treatment for these patients, as opposed to skeletal advancement procedure. Upper airway resistance syndrome (UARS) can be managed by CPAP or surgery directed at the site creating the maximum resistance. Most commonly these procedures include LAUP and/or intranasal surgery. OSAS and snoring are ongoing disease processes. Snoring, once thought to be only a social problem, may actually be a precursor to subsequent OSAS, a concept that we are now prospectively studying. Therefore, patients with the diagnosis of OSAS and snoring must be followed up throughout their lifetime. Preliminary data from this study show a significant association between weight loss and the apnea index (AHI) regardless of the treatment used.

Severe Upper Airway Obstruction in Children Secondary to Lingual Tonsil Hypertrophy

Lingual tonsil hypertrophy in children is a rarely reported disorder. Two cases of severe upper airway obstruction in pediatric patients secondary to marked lingual tonsil enlargement are reported. Both children were effectively treated with lingual tonsillectomy. The surgical technique, using an insulated Bovie tip, is described.

舌へん桃のＸ線学的検討

The degree of lingual tonsil hypertrophy was examined in 197 patients by lateral radiographs of the throat. Two parameters were designed on the radiograph: 1) the relationship between the lingual tonsil and the epiglottis, which was classified into three types, free (no touching), tip touching and total touching; 2) the percentage of the pharyngeal cavity occupied by the lingual tonsil. Patients were divided into two groups: with or without abnormal sensation in the throat. In those without abnormal sensation, tip touching and total touching types were found in only 18.1 and 7.2%, respectively. Of those with abnormal sensation more than 50% had tip or total touching tonsils. In females with abnormal sensation in the throat 42.4±14.5% of the pharyngeal cavity was occupied by the lingual tonsils, while in those without abnormal sensation 35.3±10.6% was occupied by the lingual tonsils. The figure was a significant difference. In the males no significant difference was found between the groups with and without abnormal sensation. It is concluded that the touching of the epiglottis and the lingual tonsil and the hypertrophy of the lingual tonsil, especially in females, may play a role in the incidence of abnormal sensation of the throat.

舌へん桃肥大に対するレーザー手術の適応

Thirteen patients with hypertrophied lingual tonsils were treated with laser surgery in the ENT department of Heidberg Hospital, Hamburg. Hypertrophy of the lingual tonsils probably develops as a compensatory enlargement following palatine tonsillectomy. It may be true that repeated infection (lingual tonsillitis) in younger patients participates in the development of lingual tonsil hypertrophy. CO2 laser surgery was used instead of surgical dissection with scissors or a tonsillotome. We conclude that CO2 laser application is a better treatment of hypertrophy of the lingual tonsil than earlier techniques since it causes minimal bleeding during surgery, only slight postoperative scarring, no damage to surrounding tissues and minor postoperative pain.

Carbon dioxide laser surgery of the tongue base

Surgery for benign lesions at the tongue base has, to date, been limited, and little attention has been paid to lingual tonsillitis and lingual tonsil hypertrophy. One of the reasons for this has been an unsatisfactory surgical technique with a significant morbidity. Fifteen patients treated with the carbon dioxide laser for lesions at the tongue base are presented in this paper to show that this surgical technique offers advantages to both the surgeon and the patients.