Tongue base procedures for obstructive sleep apnea-How I do it

Since Fujita's original description of 3 airway types, many surgeons have realized that most patients with obstructive sleep apnea (OSA) exhibit multilevel obstruction of the airway with primary site at the level of the tongue. Many of these patients were found to have true macroglossia vs others who simply had prominent lingual tonsil or prominent base of tongue. Moore further classified base of tongue as high tongue base type A, high tongue base with retroepiglottic narrowing type B1, type B2 diffuse tongue base narrowing, and type C (isolated retroepiglottic narrowing). However, most of the newer surgical procedures for the treatment of OSA have been concentrating on the palatal obstruction. We have been able to define physiological aspects of obstruction at the level of hard and soft palate, understand muscle dynamics of the area, and apply this knowledge to our surgical approaches. Surgical approaches to the tongue, even though performed for many years and are well supported by the literature, still remain controversial. Therefore, tongue procedures for OSA have employed various tools, including traditional diathermy, lasers, radiofrequency probes, coblation plasma technology, and administered by human hand as well as robotically assisted. Extent of volumetric tongue reduction also varies from simple radiofrequency channeling to lingual tonsillectomy to midline partial glossectomy with or without associated linguoplasty or even more extended posterior glossectomy.