Obstructive sleep apnoea (OSA) is often a multi-level upper airway disorder in which anatomic factors in the throat, oral cavity and the nose collectively leads to obstruction during sleep.
- Nasal factors include adenoid hypertrophy, turbinate hypertrophy and deviated septum.
- Oral cavity factors include uvular-palatal hypertrophy, large tonsils and large tongue.
- Factors in the throat include large base of tongue and problems related to the voicebox which is rare.
Diagnosis of a Large Base of Tongue
The base of tongue is the back part of the tongue which curves down the throat. Lingual tonsils also contribute to the size of this region as well. Most of the patients who suffer from OSA, this region is quite large and is prone to collapsing backwards during sleep leading to obstruction. This may also occur in individuals who are not obese.
Fibreoptic laryngoscopy is the only way to know if a patient has a large tongue of base. It is also necessary to perform a sedated endoscopy to ensure that the base of tongue is causing obstruction when asleep.
Another way to suspect a large base of tongue is when a patient has persistent OSA even if their oral cavity and nasal cavity is wide open. These patients often have persistent OSA in spite of having undergone a number of surgical procedures including tonsillectomy and adenoidectomy, septoplasty, turbinate reduction and UPPP.
Base of Tongue Reduction Procedure
Base of tongue reduction is a method that actually addresses the size of this region rather than just manipulate or shift the tongue position. Coblation is a technique that is used to literally remove part of the base of tongue bulk (a submucosal partial glossectomy) without any external neck incision.
The submucosal base of tongue reduction partial glossectomy is performed by making a small incision in the centre of the tongue and inserting the coblation wand through the incision and into the muscular bulk of the base of tongue. The base of tongue tissue bulk is then liquefied and suctioned out. This procedure is not similar to somnoplasty or tongue-channeling. However, it can be compared to liposuction, but instead of fat, muscle and tissue stroma are the ones removed. Although muscle is being removed with this procedure, if the surgery is successfully performed, talking and swallowing is no more affected than that experienced after tonsillectomy. This procedure is often called base of tongue coblation because coblation is used.
Recovery After a Tongue Reduction Procedure
Patients usually report that the pain is about 75% of that experienced after a regular tonsillectomy. Normal talking, normal swallowing and pain resolution usually occurs about 10 days following the procedure. The procedure normally takes 15 minutes to perform and it is done under general anesthesia. Patient s spend a night at the hospital due to the location of the surgery, before being discharged the following day.
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