Lingual tonsillectomy and midline posterior glossectomy for obstructive sleep apnea

Obstructive sleep apnea syndrome (OSA) results from the interaction between a structurally small and vulnerable upper airway and loss of compensatory reflexes. Surgical treatment is indicated in patients who fail medical treatment and aims to reduce obstruction by increasing airway size and decreasing collapsibility. Common components of airway obstruction in obstructive sleep apnea are relative macroglossia and lingual tonsil enlargement, both of which are amenable to surgical reduction. A technique is described that uses transoral, angled lens, rigid fiber-optic scopes with video camera to provide visualization and a malleable plasma surgery tool for tissue removal. Using this technique as part of a multilevel surgical approach, the apnea-hypopnea index was significantly reduced. Postoperative morbidity was generally low and included postoperative pain, dysphagia, transient change in taste, and bleeding. Patients were monitored in the outpatient ward and were discharged the morning following surgery. No patient required tracheotomy.