Tongue Base Is Obstructing The Airway in Sleep Apnea Patient

Tongue base (TB) is narrowing the upper airway in obstructive sleep apnea patient

Tongue base can cause hypopharyngeal area, airway obstruction and sleep apnea.

Snoring, difficulty breathing while lying on his back, sleep apnea (sleep apnea), night sweats, tired waking and feeling tired during the day, the patient had complaints of tongue base and loose larynx structure due to the airway closure photos (Photos, flexible nasopharyngoscopy - sleep obtained during endoscopy). This patient was recommended to undergo therapeutic weight loss, regular gait, lifestyle changes, and, if complaints persisted, laser, radiofrequency or other surgical procedures for the base of the tongue.

The base of the tongue is a common hypopharyngeal obstruction in sleep apnea

The base of the tongue is a common hypopharyngeal obstruction in sleep apnea. Patients with small or regressive jaws increase the risk of obstruction due to tongue base. Occasionally, naroowing of airway can result from an enlarged tongue. In this environment, obstruction occurs when the base of the tongue hits the airway just above the glottis.

Weight loss may help patient who has oairway obstruction arising from the tongue base region

Especially in patients who are overweight and have high body mass index (BMI), if they lose 10% of their body weight, it is more likely that their complaints arising from the tongue base region will decrease. Therefore, if the body mass index is found to be high in patients with isolated tongue base problems, techniques for weight loss should be tried before planning the operation. In patients with significant soft palate pathology, if there is moderate or severe apnea, nose and palate surgery can be performed primarily. Prevention of apnea in both groups during the study to lose weight. A positive compressed air mask (CPAP) should be used if necessary to accelerate metabolism. In the dietitian control, carbohydrate restriction, diets to increase metabolism and antioxidant diets can be recommended.

Problems detected in the tongue base region may be in the form of tongue aor only base region of tongue, the size of the lower jaw is small or behind because of the position of the tongue behind, or normal tongue and jaw anatomy during sleep, muscle loosening of the tongue slips back and obstructs the respiratory tract. In addition to standard ENT examination and nasal examination with flexible endoscopes, sleep endoscopy should be performed and the level and content of the problem should be evaluated during sleep and the most appropriate surgical approach should be decided for the solution of the present problem. Due to the localization of the tongue base region, surgery may be troublesome for both the patient and the surgeon, and postoperative problems and complication risks are relatively high. There are different surgical techniques applied at the base of the tongue.

Treatment of Sleep Apnea Sydrome Due To Tongue Base Problems

Reducing the volume of tongue base

Surgery is performed to reduce the volume of the tongue base in patients with large sized tongue base due to obstruction of the respiratory tract by examination and sleep endoscopy. The tongue base region can be intervened externally by the neck or through the mouth. As a result of advances in medical technology, neck approach is generally not preferred today.

Tongue base radiofrequency

Radiofrequency applications on the tongue base are based on the principle of shrinkage of heat damage created by using radiofrequency energy in the tongue base soft tissues and contraction of the tissue volume while the formation of hard healing tissue. It is a disadvantage. This technique can be applied in combination with nose and or palate surgery in the same session in patients with sleep apnea with tongue base growth. In radiofrequency procedure compared to other methods applied in this region, the probability of complications and post-procedure problems are significantly less, but the success rate is less.

Laser or coblation 

It is the process of decreasing the volume of soft tissues in the midline of the tongue root with the help of an intra-oral laser or Coblator device. This method, which is applied for the removal of soft tissues under the tongue mucosa, is called SMILE (Submucous minimally invasive tongue excision). During the same procedure, it is also possible to reduce the tongue base lymph tissue (lingual tonsils) and some laryngeal structures. After these surgeries, a temporary neck-to-air tube placement (Tracheotomy) may be required in case of airway obstruction due to swelling of the tissues or bleeding. Robotic Tongue base surgery: Robot technology has started to be used successfully in surgical interventions in the difficult-to-reach, limited-sighted tongue basearea following the development of equipment suitable for oral use.

Apart from these applications, there are different procedures such as "advancing the muscle that attracts the tongue, hanging the hyoid bone with suture, hanging the tongue base with suture".

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

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