Abstract
Obstructive sleep apnea/hypopnea syndrome (OSAHS) is a disease entity that may involve multiple levels of the upper airway from the level of nose down to glottis. The recognition of the important contribution of base of tongue (BOT) obstruction to OSAHS led to the development of multiple surgical techniques and approaches directed at the BOT level. Transoral robotic surgery (TORS)-assisted BOT reduction is one such technique, first reported by Vicini. Although TORS-assisted BOT reduction is most commonly combined with other upper airway procedures to treat OSAHS, it can potentially be used as a stand-alone surgical modality in properly selected patients. Drug induced sleep endoscopy (DISE) is a valuable diagnostic tool in localizing the site, identifying the pattern, and determining the severity of upper airway obstruction. We have shown that the use of TORS-assisted BOT reduction alone can be effective in reducing apnea hypopnea index (AHI), Epworth sleepiness scale (ESS) score, and snoring intensity in patients with obstruction identified at the BOT level. Complications associated with TORS-assisted BOT reduction included taste disturbance, oropharyngeal stenosis, and bleeding.
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References
Fujita S, Conway W, Zorick F, Roth T. Surgical correction of anatomic abnormalities in obstructive sleep apnea syndrome: uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg. 1981;89:923–34.
Sher AE, Schechtman KB, Piccirillo JF. The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. Sleep. 1996;19:156–77.
Fujita S, Woodson BT, Clark JL, Wittig R. Laser midline glossectomy as a treatment for obstructive sleep apnea. Laryngoscope. 1991;101:805–9.
Soares D, Sinawe H, Folbe AJ, et al. Lateral oropharyngeal wall and supraglottic airway collapse associated with failure in sleep apnea surgery. Laryngoscope. 2012;122:473–9.
Ravesloot MJ, de Vries N. One hundred consecutive patients undergoing drug-induced sleep endoscopy: results and evaluation. Laryngoscope. 2011;121:2710–6.
Riley RW, Powell NB, Guilleminault C. Maxillofacial surgery and obstructive sleep apnea: a review of 80 patients. Otolaryngol Head Neck Surg. 1989;101:353–61.
Riley RW, Powell NB, Guilleminault C. Obstructive sleep apnea and the hyoid: a revised surgical procedure. Otolaryngol Head Neck Surg. 1994;111:717–21.
Woodson BT. A tongue suspension suture for obstructive sleep apnea and snorers. Otolaryngol Head Neck Surg. 2001;124:297–303.
Woodson BT, Nelson L, Mickelson S, Huntley T, Sher A. A multi-institutional study of radiofrequency volumetric tissue reduction for OSAS. Otolaryngol Head Neck Surg. 2001;125:303–11.
Maturo SC, Mair EA. Submucosal minimally invasive lingual excision: an effective, novel surgery for pediatric tongue base reduction. Ann Otol Rhinol Laryngol. 2006;115:624–30.
Lin AC, Koltai PJ. Persistent pediatric obstructive sleep apnea and lingual tonsillectomy. Otolaryngol Head Neck Surg. 2009;141:81–5.
Rotenberg B, Tan S. Endoscopic-assisted radiofrequency lingual tonsillectomy. Laryngoscope. 2011;121:994–6.
Riley RW, Powell NB, Guilleminault C. Obstructive sleep apnea syndrome: a review of 306 consecutively treated surgical patients. Otolaryngol Head Neck Surg. 1993;108:117–25.
Van de Heyning PH, Badr MS, Baskin JZ, et al. Implanted upper airway stimulation device for obstructive sleep apnea. Laryngoscope. 2012;122:1626–33.
Caples SM, Rowley JA, Prinsell JR, et al. Surgical modifications of the upper airway for obstructive sleep apnea in adults: a systematic review and meta-analysis. Sleep. 2010;33:1396–407.
Weinstein GS, O'Malley BW, Cohen MA, Quon H. Transoral robotic surgery for advanced oropharyngeal carcinoma TORS for advanced oropharyngeal carcinoma. Arch Otolaryngol Head Neck Surg. 2010;136:1079–85.
Weinstein GS, O'Malley Jr BW, Snyder W, Hockstein NG. Transoral robotic surgery: supraglottic partial laryngectomy. Ann Otol Rhinol Laryngol. 2007;116:19–23.
Weinstein GS, O'Malley Jr BW, Snyder W, Sherman E, Quon H. Transoral robotic surgery: radical tonsillectomy. Arch Otolaryngol Head Neck Surg. 2007;133:1220–6.
O'Malley Jr BW, Weinstein GS, Snyder W, Hockstein NG. Transoral robotic surgery (TORS) for base of tongue neoplasms. Laryngoscope. 2006;116:1465–72.
Vicini C, Dallan I, Canzi P, et al. Transoral robotic surgery of the tongue base in obstructive sleep apnea-hypopnea syndrome: anatomic considerations and clinical experience. Head Neck. 2012;34:15–22.
Friedman M, Hamilton C, Samuelson CG, et al. Transoral robotic glossectomy for the treatment of obstructive sleep apnea-hypopnea syndrome. Otolaryngol Head Neck Surg. 2012;146:854–62.
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;72:22–7.
Lin HS, Rowley JA, Badr MS, et al. Transoral robotic surgery for treatment of obstructive sleep apnea-hypopnea syndrome. Laryngoscope. 2013;123:1811–6.
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;125:1013–20.
Heiser C, Landis BN, Giger R, et al. Taste disorders after tonsillectomy: a long-term follow-up. Laryngoscope. 2012;122:1265–6.
Lauretano AM, Li KK, Caradonna DS, Khosta RK, Fried MP. Anatomic location of the tongue base neurovascular bundle. Laryngoscope. 1997;107:1057–9.
Hou T, Shao J, Fang S. The definition of the V zone for the safety space of functional surgery of the tongue. Laryngoscope. 2012;122:66–70.
Murphey AW, Kandl JA, Nguyen SA, Weber AC, Gillespie MB. The effect of glossectomy for obstructive sleep apnea: a systematic review and meta-analysis. Otolaryngol Head Neck Surg. 2015;153:334–42.
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Lin, HS. (2016). Transoral Robotic Surgery as Single Level Surgery for Treatment of Obstructive Sleep Apnea. In: Vicini, C., Hoff, P., Montevecchi, F. (eds) TransOral Robotic Surgery for Obstructive Sleep Apnea. Springer, Cham. https://doi.org/10.1007/978-3-319-34040-1_8
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DOI: https://doi.org/10.1007/978-3-319-34040-1_8
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