Modified tongue base suspension for multilevel or single level obstructions in sleep apnea: clinical and radiologic results

Objectives

To investigate the radiologic and polysomnographic success in opening the airway using a tongue base suspension procedure alone or in combination with uvulopalatal flap in obstructive sleep apnea syndrome (OSAS) patients.

Methods

This study was conducted in 20 patients with moderate or severe OSAS in a prospective manner. The tongue base suspension technique alone or with a uvulopalatal flap (UPF) technique was applied. Magnetic resonance imaging (MRI) scans of patients obtained during the preoperative period and at the 5th week of the postoperative period were compared. Changes in pain and swallowing difficulties were assessed. Polysomnography (PSG) was applied at the 12th postoperative month, and body mass index (BMI) and Epworth sleepiness scale (ESS) values were determined. The degree of satisfaction relative to the surgery was assessed with 4 questions.

Results

Preoperative apnea-hypopnea index (AHI) level was found to be 24.55 ± 9.87, whereas postoperative AHI level was 12.40 ± 9.87 (P < 0.01). The success rate was determined to be 60%. Preoperative ESS values were 13.90 ± 2.67 and were reduced to 6.55 ± 3.13 postoperatively (P < 0.01), and the preoperative posterior airway space (PAS) level was 10.08 ± 1.23, which was increased to 11.64 ± 1.46 postoperatively (P < 0.01). Visual analog scale (VAS) values for swallowing difficulty were 8.62 at day 1 and decreased to 3.98 at day 7. The VAS values for pain were 9.14 at day 1, but were reduced to 4.18 at day 7.

Conclusions

Patients with OSAS who have hypertrophy of the tongue base may safely receive a tongue base suspension procedure, which is a minimally invasive method. The postoperative hospital stay is short and the success rate is high, as shown with both PSG and MRI.