Tongue Base Surgery for Obstructive Sleep Apnea
Blockage or obstruction of the airway due to the tongue is extremely common in patients with obstructive sleep apnea. Over half of patients with sleep apnea have at least some level of obstruction at this site.
There are many reasons why obstruction occurs at this level.
Facial Skeletal Anatomy: One reason may be due to facial anatomy, as patients with a small jaw or set-back chin do not allow for space in the mouth for the tongue. The tongue will then easily fall back and block the airway.
Large Lingual Tonsils: Large lingual tonsils, or tonsil tissue at the very back of the tongue, can be another reason for collapse of the airway at this level.
Large Tongue: More recent research also has shown some individuals to have more fatty tissue in the tongue, which can predispose patients to more collapse from the tongue.
Mouthbreathing at Night: Patients who breathe mainly through their mouth at night, often due to poor ability to breathe through their nose, often have obstruction at the back of the tongue, as the tongue will fall back when the mouth opens at night.
Decreased Tongue Muscle Activity: While we know that throat and tongue muscles relax when we sleep, many people with sleep apnea have lower tongue muscle activity in key muscles (ie: genioglossus, geniohyoid), which can predispose to more tongue base obstruction.
What Kind of Sleep Surgeries are there for the Tongue Base?
Dr. Phillips will be able to determine, through examination and a short procedure, called drug-induced sleep endoscopy, whether a person may benefit from surgery at the tongue or tongue base.
While most people are aware of the palatine tonsils in the throat, which can be seen when looking in the back of the throat, we also have similar tissue at the very back of the tongue, called lingual tonsils. These cannot be seen easily by looking in the mirror. When this tonsil tissue is large, it can block the airway. Dr. Phillips can perform a simple procedure to reduce the size of these tonsils significantly, to greatly improve the airway and help with sleep apnea. This surgery is performed while a patient is asleep (general anesthesia), and there are no external incisions, as the surgery is performed through the mouth.
In some cases, when the tongue is large in size, or the jaw is small in size, a reduction in the size of the back of the tongue can be extremely helpful in creating a wider airway for breathing at night. Dr. Phillips often performs this minimally invasive surgery which consists of removing a small portion of the middle and back of the tongue to reduce the size. He uses the newest medical technology to do this, called Coblation(R), which preserves the normal tongue tissue surrounding the incision and reduces pain and swelling. This surgery is also performed while a patient is asleep (general anesthesia), and there are no external incisions, as the surgery is performed through the mouth.
This is a commonly used procedure that acts to reduce the size of the back of the tongue by creating a controlled area of tissue destruction using heat from a small radio frequency probe inserted into the tongue at different key spots. The tongue heals by scarring under the surface of the tongue, which leads to a reduction in tongue size. This can be very effective in people with snoring or sleep apnea, and can be performed either in the operating room, or in the clinic, under certain circumstances. In some cases, more than one treatment session is needed to achieve the desired result, however most people report minimal pain after the procedure. Dr. Phillips will be able to determine if this surgery, is appropriate to achieve a patient’s desired goals.