Surgical treatment of Obstructive sleep apnea:
Tongue base surgery and hypoglossal nerve stimulation
Abstract Introduction: The diagnosis and surgical management of the obstruction of the base of the tongue in OSA continues to be a challenge for most sleep surgeons. In recent years, there has been a significant improvement in knowledge and a decrease in morbidity. Synthesis: Surgical techniques aimed at treating tongue base collapse can be divided into techniques that modify the anatomy and techniques that stimulate the upper airway. Conclusions: Technological developments and the evolution of the different surgical techniques have been constant in the last decade and will probably change even more in the coming years. Upper airway stimulation surgery has opened the frontiers in the treatment of OSA.
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Yu R, Huang C, Chang C, Wang Y, Chen J. Prevalence and patterns of tongue deformation in obstructive sleep apnea: A whole-night simultaneous ultrasonographic and polysomnographic study. J Sleep Res. 2021;30:e13131.
Kezirian EJ, Goldberg AN. Hypopharyngeal surgery in obstructive sleep apnea: An evidence-based medicine review. Arch Otolaryngol Head Neck Surg; 2006;132:206–13.
Baptista PM, Garaycochea O, O’Connor C, Plaza G. Tongue Surgery That Works in OSA. Curr. Otorhinolaryngol. Rep. 2021;9(4):285-293.
Fujita S, Woodson BT, Clark JL, Wittig R. Laser Midline Glossectomy as a Treatment for Obstructive Sleep Apnea. Laryngoscope. 1991;101:805-809.
Mickelson SA, Rosenthal L. Midline glossectomy and epiglottidectomy for obstructive sleep apnea syndrome. Laryngoscope. 1997;107:614–9.
Powell NB, Riley RW, Guilleminault C. Radiofrequency tongue base reduction in sleep-disordered breathing: A pilot study. Otolaryngol Head Neck Surg. 1999;120:656–64.
Baba RY, Mohan A, Metta VVSR, Mador MJ. Temperature controlled radiofrequency ablation at different sites for treatment of obstructive sleep apnea syndrome: a systematic review and meta-analysis. Sleep Breath. 2015;19:891–910.
Friedman M, Soans R, Gurpinar B, Lin HC, Joseph N. Evaluation of submucosal minimally invasive lingual excision technique for treatment of obstructive sleep apnea/hypopnea syndrome. Otolaryngol Head Neck Surg. 2008;139(3):378-384.
Babademez MA, Yorubulut M, Yurekli MF, Gunbey E, Baysal S, Acar B, et al. Comparison of minimally invasive techniques in tongue base surgery in patients with obstructive sleep apnea. Otolaryngol Head Neck Surg. 2011;145(5):858-864.
Vicini C, Dallan I, Canzi P, Frassineti S, La Pietra MG, Montevecchi F. Transoral robotic tongue base resection in obstructive sleep apnoea-hypopnoea syndrome: A preliminary report. ORL J Otorhinolaryngol Relat Spec. 2010;72(1):22-27.11.
Justin GA, Chang ET, Camacho M, Brietzke SE. Transoral Robotic Surgery for Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis. Otolaryngol Head Neck Surg. 2016;155(5):835-846.
Lin HS, Rowley JA, Folbe AJ, Yoo GH, Badr MS, Chen W. Transoral robotic surgery for treatment of obstructive sleep apnea: Factors predicting surgical response. Laryngoscope. 2015;125(4):1013-1020.
Vicini C, Montevecchi F, Campanini A, Dallan I, Hoff PT, Spector ME, et al. Clinical outcomes and complications associated with TORS for OSAHS: A benchmark for evaluating an emerging surgical technology in a targeted application for benign disease. ORL J Otorhinolaryngol Relat Spec. 2014;76(2):63-69.
Handler E, Hamans E, Goldberg AN, Mickelson S. Tongue suspension: An evidence-based review and comparison to hypopharyngeal surgery for OSA. Laryngoscope. 2014;124(3):329-336.
Strollo PJ Jr., Soose RJ, Maurer JT, de Vries N, Cornelius J, Froymovich O, et al. Upper-airway stimulation for obstructive sleep apnea. N Engl J Med. 2014;370(2):139-149.
Baptista PM, Garaycochea O, Álvarez-Gómez L, Alcalde J, Alegre M, Urrestarazu E. Hypoglossal nerve stimulation surgery for obstructive sleep apnoea: Our preliminary experience. Acta Otorrinolaringol Esp (Engl Ed). 2018;69(1):42-47.
Costantino A, Rinaldi V, Moffa A, Luccarelli V, Bressi F, Cassano M, et al. Hypoglossal nerve stimulation long-term clinical outcomes: a systematic review and meta-analysis. Sleep Breath. 2020;24(2):399-411.
Kompelli AR, Ni JS, Nguyen SA, Lentsch EJ, Neskey DM, Meyer TA. The outcomes of hypoglossal nerve stimulation in the management of OSA: A systematic review and meta-analysis. World J Otorhinolaryngol Head Neck Surg. 2019;5(1):41-48.
Huntley C, Steffen A, Doghramji K, Hofauer B, Heiser C, Boon M. Upper Airway Stimulation in Patients With Obstructive Sleep Apnea and an Elevated Body Mass Index: A Multi-institutional Review. Laryngoscope. 2018;128(10):2425-2428.
Woodson BT, Strohl KP, Soose RJ, Gillespie MB, Maurer JT, de Vries N, et al. Upper Airway Stimulation for Obstructive Sleep Apnea: 5-Year Outcomes. Otolaryngol Head Neck Surg. 2018;159(1):194-202.
Neruntarat C, Wanichakorntrakul P, Khuancharee K, Saengthong P, Tangngekkee M. Upper airway stimulation vs other upper airway surgical procedures for OSA: a meta-analysis. Sleep Breath. 2021;25(3):1547-1556.
Bohorquez D, Mahmoud AF, Yu JL, Thaler ER. Upper airway stimulation therapy and sleep architecture in patients with obstructive sleep apnea. Laryngoscope. 2020;130(4):1085-1089.
Kezirian EJ, Goldberg AN. Hypopharyngeal surgery in obstructive sleep apnea: An evidence-based medicine review. Arch Otolaryngol Head Neck Surg; 2006;132:206–13.
Baptista PM, Garaycochea O, O’Connor C, Plaza G. Tongue Surgery That Works in OSA. Curr. Otorhinolaryngol. Rep. 2021;9(4):285-293.
Fujita S, Woodson BT, Clark JL, Wittig R. Laser Midline Glossectomy as a Treatment for Obstructive Sleep Apnea. Laryngoscope. 1991;101:805-809.
Mickelson SA, Rosenthal L. Midline glossectomy and epiglottidectomy for obstructive sleep apnea syndrome. Laryngoscope. 1997;107:614–9.
Powell NB, Riley RW, Guilleminault C. Radiofrequency tongue base reduction in sleep-disordered breathing: A pilot study. Otolaryngol Head Neck Surg. 1999;120:656–64.
Baba RY, Mohan A, Metta VVSR, Mador MJ. Temperature controlled radiofrequency ablation at different sites for treatment of obstructive sleep apnea syndrome: a systematic review and meta-analysis. Sleep Breath. 2015;19:891–910.
Friedman M, Soans R, Gurpinar B, Lin HC, Joseph N. Evaluation of submucosal minimally invasive lingual excision technique for treatment of obstructive sleep apnea/hypopnea syndrome. Otolaryngol Head Neck Surg. 2008;139(3):378-384.
Babademez MA, Yorubulut M, Yurekli MF, Gunbey E, Baysal S, Acar B, et al. Comparison of minimally invasive techniques in tongue base surgery in patients with obstructive sleep apnea. Otolaryngol Head Neck Surg. 2011;145(5):858-864.
Vicini C, Dallan I, Canzi P, Frassineti S, La Pietra MG, Montevecchi F. Transoral robotic tongue base resection in obstructive sleep apnoea-hypopnoea syndrome: A preliminary report. ORL J Otorhinolaryngol Relat Spec. 2010;72(1):22-27.11.
Justin GA, Chang ET, Camacho M, Brietzke SE. Transoral Robotic Surgery for Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis. Otolaryngol Head Neck Surg. 2016;155(5):835-846.
Lin HS, Rowley JA, Folbe AJ, Yoo GH, Badr MS, Chen W. Transoral robotic surgery for treatment of obstructive sleep apnea: Factors predicting surgical response. Laryngoscope. 2015;125(4):1013-1020.
Vicini C, Montevecchi F, Campanini A, Dallan I, Hoff PT, Spector ME, et al. Clinical outcomes and complications associated with TORS for OSAHS: A benchmark for evaluating an emerging surgical technology in a targeted application for benign disease. ORL J Otorhinolaryngol Relat Spec. 2014;76(2):63-69.
Handler E, Hamans E, Goldberg AN, Mickelson S. Tongue suspension: An evidence-based review and comparison to hypopharyngeal surgery for OSA. Laryngoscope. 2014;124(3):329-336.
Strollo PJ Jr., Soose RJ, Maurer JT, de Vries N, Cornelius J, Froymovich O, et al. Upper-airway stimulation for obstructive sleep apnea. N Engl J Med. 2014;370(2):139-149.
Baptista PM, Garaycochea O, Álvarez-Gómez L, Alcalde J, Alegre M, Urrestarazu E. Hypoglossal nerve stimulation surgery for obstructive sleep apnoea: Our preliminary experience. Acta Otorrinolaringol Esp (Engl Ed). 2018;69(1):42-47.
Costantino A, Rinaldi V, Moffa A, Luccarelli V, Bressi F, Cassano M, et al. Hypoglossal nerve stimulation long-term clinical outcomes: a systematic review and meta-analysis. Sleep Breath. 2020;24(2):399-411.
Kompelli AR, Ni JS, Nguyen SA, Lentsch EJ, Neskey DM, Meyer TA. The outcomes of hypoglossal nerve stimulation in the management of OSA: A systematic review and meta-analysis. World J Otorhinolaryngol Head Neck Surg. 2019;5(1):41-48.
Huntley C, Steffen A, Doghramji K, Hofauer B, Heiser C, Boon M. Upper Airway Stimulation in Patients With Obstructive Sleep Apnea and an Elevated Body Mass Index: A Multi-institutional Review. Laryngoscope. 2018;128(10):2425-2428.
Woodson BT, Strohl KP, Soose RJ, Gillespie MB, Maurer JT, de Vries N, et al. Upper Airway Stimulation for Obstructive Sleep Apnea: 5-Year Outcomes. Otolaryngol Head Neck Surg. 2018;159(1):194-202.
Neruntarat C, Wanichakorntrakul P, Khuancharee K, Saengthong P, Tangngekkee M. Upper airway stimulation vs other upper airway surgical procedures for OSA: a meta-analysis. Sleep Breath. 2021;25(3):1547-1556.
Bohorquez D, Mahmoud AF, Yu JL, Thaler ER. Upper airway stimulation therapy and sleep architecture in patients with obstructive sleep apnea. Laryngoscope. 2020;130(4):1085-1089.
Baptista-Jardin, P., Garaycochea-Mendoza del Solar, O., O’Connor-Reina, C., Martínez-Ruiz-de Apodaca , P., Marco-Garrido, A., Plaza-Mayor, G., & Carrasco-Llatas, M. (2023). Surgical treatment of Obstructive sleep apnea:: Tongue base surgery and hypoglossal nerve stimulation. Revista ORL, e30977. https://doi.org/10.14201/orl.30977
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