SLEEP-DISORDERED BREATHING DIAGNOSIS AND TREATMENTkapak

TONGUE BASE SURGERIES IN OSAS

Kerimcan Çakıcı

Uşak University, Faculty of Medicine, Department of Otorhinolaryngology, Uşak, Türkiye

Çakıcı K. Tongue Base Surgeries in OSAS. In: Özcan KM, editor. Sleep-Disordered Breathing: Diagnosis and Treatment. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.157-173.

ABSTRACT

In the surgical management of obstructive sleep apnea syndrome (OSAS), interventions targeting the base of the tongue should be approached comprehensively. As one of the primary contributors to upper airway obstruction, tongue base collapse requires special consideration during both diagnosis and treatment due to its complex anatomy and challenging surgical access. The anatomical and histological characteristics of this region play a critical role in shaping the diversity of available intervention strategies.

Surgical approaches necessitate a thorough analysis of patient-specific factors such as body mass index (BMI), apnea-hypopnea index (AHI), and the level of airway obstruction. Tongue base surgeries are typically considered in the presence of multilevel obstruction and are often combined with other upper airway procedures. In this context, accurate localization of the obstruction and understanding its pathophysiological mechanism form the foundation for successful treatment planning.

This chapter provides a comparative evaluation of various aspects of tongue base surgeries, including invasiveness, efficacy, complication risk, and patient selection. It presents a broad spectrum of interventions ranging from traditional tissue resection techniques to nerve stimulation–based methods. Radiofrequency therapy is applied to the tongue base by delivering 350-750 joules of energy to 3-4 different locations around the midline. Repeat treatments are recommended after a minimum of 3-4 weeks. It can be applied to the tongue base alone or to the soft palate and tongue base in the same session. Studies have reported successful results with multilevel radiofrequency therapy. Tongue base coblation, commonly used today, utilizes cold tissue ablation with ionizing plasma energy. Midline glossectomy, submucous resection, or lingual tonsillectomy can be performed at the tongue base with a coblator. Published articles have reported low complication rates. Tongue base coblation can be performed as part of a multilevel surgery. Transoral robotic tongue base (TORS) surgery is a technique successfully used in OSAS patients with adequate mouth opening and retrolingual collapse due to tongue base hypertrophy. Suitable patients for TORS include those who are unresponsive to PAP therapy, have moderately severe OSAS, and those with collapse at the tongue base on sleep endoscopy. Hypoglossal nerve stimulation is another effective method at the base of the tongue. It stimulates the genioglossus muscle, the major dilator muscle of the upper airway, to open the upper airway. By comparing fundamental and emerging approaches alongside current clinical evidence, the chapter aims to serve as a practical guide for otolaryngologists involved in the management of OSAS.

Keywords: Sleep apnea; Surgery; Tongue base; Ablation techniques; Radiofrequency ablation; Robotic surgical procedures; Hypoglossal nerve stimulation

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