This document discusses various surgical options for treating sleep apnea, including radiofrequency of the base of the tongue, tongue base suspension, percutaneous submucosal tongue base excision, submucosal minimally invasive lingual excision (SMILE), mandibular osteotomy with genioglossus advancement (MOGA), and hyoid surgery. It provides details on the procedures, such as using RF energy or sutures to advance the tongue forward, making small incisions to resect tongue base tissue, and sliding the mandible or hyoid bone forward. The document notes that while these surgeries aim to enlarge the airway, CPAP remains the gold standard treatment for sleep apnea.

1. Dr Zeeshan Ahmad Deptt of ENT,
14th November 2012
M.S.(ENT,PGY1) NMCH, Patna.

3. What Sleep Apnea actually looks like??
This guy had an apnea episode lasting 13 seconds.
Significant enough to label as sleep apnea(>10 secs).

4. OPTIONS
 Radiofrequency of base of tongue
 Tongue base suspension
 Percutaneous submucosal tongue base excision
 Submucosal minimally invasive lingual excision
 Mandibular osteotomy with genioglossus
advancement
 Hyoid surgery

5. Hypoglossal Neurovascular Bundle
Anatomy
 Inferolateral in tongue
base
 Midway between
midline and lateral
tongue margin
 Stays close to superior
margin of hyoid (0.9cm)
 2.7 cm inferior and 1.6cm
lateral to foramen cecum
 Allows for aggressive
tongue base reduction

6. Radiofrequency of base of tongue
 If the upper airway exploration assesses the
retrolingual narrowed area in OSA patient.
 RF is the more conservative procedure.
 A device from GyrusENT, with a hand piece is
especially used for tongue surgery.
 1200 joules of total energy is delivered.
 Care is taken not to injure neuro-vascular bundle.
 Foreign body sensation, pain, hematoma, abscess, etc
are the complications.

7. Tongue base suspension
 This idea of Glossopexy first came in 1992 when Fascia
Lata was used to anteriorly suspend the tongue to the
mandible.
 Now REPOSE SYSTEM is available which uses
polypropylene suture for suspension.

8. Percutaneous submucosal tongue
base excision
 A suprahyoid neck skin incision is given.
 A Plasma-mediated RF(coblation) device is used.
 Good technique but complicated approach.
 So did not became popular.

9. Submucosal minimally invasive
lingual excision(SMILE)
 Intraoral technique.
 First reported in 2006 for t/t of macroglossia
associated with Down’s syndrome & Beckwith
Wiedemann syndrome.
 A small incision on the dorsal side of tongue under
GA.
 Initiate the resection with special care to stay medial
and advance in posterior direction.
 Moving in superior inferior fashion.

10. (SMILE) continued…
 Blood loss is minimum and edema is controlled by the
use of iv corticoids.
 Oral antibiotics are mandatory.

14. Mandibular Osteotomy with
Genioglossus Advancement(MOGA)
 Must always be used in combination with a hyoid
suspension in severe OSA.
 Not indicated as a unique procedure.
 10-15 mm below the gingivomucosal junction
symphysis is dissected.
 Osteotomy is performed at the genial tubercle/
genioglossus muscle complex.
 Fixed with a screw.
 Complications are pain, dysphagia, wound dehiscence,
etc.

16. Hyoid surgery
 LA or GA.
 Horizontal incision and careful dissection of fat tissue
in front of hyoid.
 Two holes in the thyroid cartilage.
 Steel wire is passed.
 Complications are dysphagia which may last upto 1
month.
 Success as a unique treatment is poor.

17. Snoring – Sleep Apnea?
 Snoring is a problem, both for the snorer and for
their bed partner
 There are solutions for snoring, but there is no
single common solution
 Researches are going on to find out some solution
surgical or non-surgical that is acceptable to patient
and at the same time effective and safe too.
 However the gold standard treatment still remains
CPAP.

18. THANK YOU