Tongue base hypertrophy plays an
important role in pathophysiology in many cases of obstructive sleep
apnea–hypopnea syndrome (OSAHS) especially severe ones. Tongue base including both
lingual tonsils and tongue base muscles may be the primary obstructing site or
may lead to secondary palatal obstruction, its surgery remains a great
challenge in those critical patients 1.
In literature, there are many
surgical techniques described to manage tongue base hypertrophy in OSAHS
patients, minimally invasive ones e.g. radiofrequency and channeling are usually
not sufficient in management of severe OSAHS cases, however surgical resection
of tongue base is the only available option to manage that obstructive
condition. 2 Transcervical tongue base resection, as described by Prof.
Chabolle F. 3, achieved excellent results however it was associated with
non-negligible postoperative morbidity; the reason that made Prof. Chabolle
himself stop doing his technique for those patients. 4
Transoral robotic surgery (TORS)
for tongue base resection in OSAHS, as described by Prof. Vicini C. 5, has
proved to provide excellent and safe transoral access to tongue base and epiglottis
with surgical precision and haemostasis. TORS was found to achieve the best
outcomes if compared versus other options for management of tongue base
hypertrophy in OSAHS patients.
The second best transoral option
found, if the robot is not available, as regards effectiveness and being
minimally invasive and not so painful (as LASER), was the CELL technique
(Coblation endoscopic lingual lightening) as described by Prof. Li HN. 6,7
However, CELL technique aimed at
ablating the lingual tonsils and obstructing tongue base by using Coblation
technology without measuring the volume of resected tissues and it took long
operative time with long exposure to anaesthesia in those critical cases.
purpose of this study is to assess feasibility and efficacy of a new surgical
technique, in countries that are lacking TORS, for management of tongue base
hypertrophy in OSAHS cases using transoral endoscopic assisted coblation
technology in resecting not ablating tongue base tissues.