Clinical Experience with Lingualplasty as Part of the Treatment of Severe Obstructive Sleep Apnea

Abstract

Because uvulopalatopharyngoplasty (UPPP) as the sole procedure for severe obstructive sleep apnea syndrome (OSAS) is often inadequate, multiple other procedures have been developed. These have been directed at other sites of potential collapse of the upper airway. Initial experience with midline glossectomy (MLG) has shown direct modification of the tongue base to be an effective procedure in a subset of patients with OSAS. Lingualplasty, a modification of MLG, is demonstrated to provide an improved response rate. Twenty-two consecutive patients with severe OSAS and Fujita type II airway classification (retropalatal, oropharyngeal, and hypopharyngeal compromise) underwent lingualplasty. Fourteen patients had previously undergone unsuccessful UPPP. Eight had synchronous lingualplasty and UPPP. All were selected for lingualplasty because of obstructive tongue base anatomy. Responders were defined as having a respiratory disturbance index (RDI) of less than 20 events/hour. For the entire group, 17 of 22 (77%) were classified as responders, with RDI decreasing from 58.8 ± 39.5 events/hour to 8.1 ± 6.2 events/hour. Lingualplasty, as an isolated procedure, resulted in a 79% responder rate, with RDI decreasing from 50.2 events/hour to 8.6 events/hour. There were no significant changes in the RDI of the nonresponder groups. No differences were identified that discriminated responders from nonresponders, including age, body mass index, or cephalometry. There were six complications (27%), including bleeding (3), tongue edema (1), prolonged odynophagia (1), and subcutaneous emphysema related to tracheotomy (1). All resolved with treatment. These results indicate that in appropriately selected patients who do not respond to UPPP, lingualplasty Is a significant improvement over MLG.