Robotic Tongue-Base Resection Combined With Tongue-Base Suspension for Obstructive Sleep Apnea.
OBJECTIVES/HYPOTHESIS
Our primary objective was to evaluate the feasibility, morbidity, and efficacy of transoral robotic surgery (TORS) tongue-base resection (TBR) combined with tongue-base suspension (TBS) for obstructive sleep apnea (OSA) with tongue-base collapse. Our secondary objective included evaluation of factors influencing treatment success.


STUDY DESIGN
Single-arm, prospective, observational cohort study.


METHODS
Patients were eligible if they had moderate-to-severe OSA (apnea hypopnea index [AHI] > 15) or positional OSA, had a tongue-base collapse and glossoptosis identified by drug-induced sleep endoscopy (DISE), and failed continuous positive airway pressure. All patients underwent TORS-TBR combined with TBS. Additionally, concomitant epiglottoplasty, uvulopalatopharyngoplasty, or expansion pharyngoplasty were performed based on DISE findings.


RESULTS
In total, 64 patients were enrolled in the trial. The mean age was 45.9 years, mean body mass index was 30.5 kg/m2 , and mean AHI was 41.7 events/hour. The mean robotic surgical time, total volume of tongue-base tissue removed, and the length of hospital stay were 21.4 minutes, 15.16 mL, and 6.5 days, respectively. Postoperatively, almost all polysomnographic metrics improved significantly (AHI = 41.72 vs. 18.82 events/hour, lowest oxygen saturation = 80.43% vs. 85.14%, Epworth Sleepiness Scale = 10.49 vs. 4.09). The procedure provided an overall success rate of 75%, with minor morbidity. All patients experienced varying degrees of temporary lingual edema postoperatively. Tracheotomy was not required for any patient. Although no independent predictor of treatment success was determined, patients with more severe disease tend to exhibit lower response to the treatment.


CONCLUSIONS
TORS-TBR combined with TBS is a feasible, safe, and efficient procedure for OSA with tongue-base collapse.


LEVEL OF EVIDENCE
4 Laryngoscope, 130:2285-2291, 2020.
['Turhan|Murat|M|', 'Bostanci|Asli|A|0000-0002-1535-2661']
D000328:Adult D003131:Combined Modality Therapy D005240:Feasibility Studies D005260:Female D005927:Glossectomy D006801:Humans D008297:Male D008875:Middle Aged D017286:Polysomnography D011446:Prospective Studies D065287:Robotic Surgical Procedures D012720:Severity of Illness Index D020181:Sleep Apnea, Obstructive D014059:Tongue D014060:Tongue Diseases D016896:Treatment Outcome
tongue-base suspension Obstructive sleep apnea robotic surgery tongue-base reduction