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Outcome of TORS to tongue base and epiglottis in patients with OSA intolerant of conventional treatment

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

Transoral robotic surgery (TORS) of the tongue base with or without epiglottoplasty represents a novel treatment for obstructive sleep apnea (OSA). The objective was to evaluate the clinical efficacy of TORS of the tongue base with or without epiglottoplasty in patients who had not tolerated or complied with conventional treatment (continuous positive airway pressure or oral appliance).

Methods

Four-year prospective case series. The primary outcome measure was the apnea-hypopnea index (AHI) in combination with the Epworth Sleepiness Score (ESS). Mean oxygen saturation levels (SaO2) before and after TORS on respective sleep studies were also recorded. Secondary outcome measures included operative time and complications. Patient reported outcome measures (PROMs) assessed included voice, swallow and quality of life.

Results

Fourteen patients underwent TORS for tongue base reduction with ten having additional wedge epiglottoplasty. A 64 % success rate was achieved with a normal post-operative sleep study in 36 % of cases at 6 months. There was a 51 % reduction in the mean AHI (36.3 ± 21.4 to 21.2 ± 24.6, p = 0.02) and a sustained reduction in the mean Epworth Sleepiness Score (p = 0.002). Mean SaO2 significantly increased after surgery compared to pre-operative values (92.9 ± 1.8 to 94.3 ± 2.5, p = 0.005). Quality of life showed a sustained improvement 3 months following surgery (p = 0.01). No major complications occurred.

Conclusions

TORS of the tongue base with or without epiglottoplasty represents a promising treatment option with minimal morbidity for selected patients with OSA. Long-term prospective comparative evaluation is necessary to validate the findings of this study.

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Acknowledgments

Special thanks to Miss Shirley Martin, clinical robotic nurse specialist and Mr. Richard Koronowski (Promed Ltd, Peterborough, UK) for providing technical support with the thulium laser.

Funding

No funding was received for this research.

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology and Head & Neck Surgery, Imperial College Healthcare NHS Trust, St Mary’s Hospital, Praed Street, London, W2 1NY, UK

    Asit Arora, Konstantinos Chaidas, George Garas, Ashik Amlani & Neil S Tolley

  2. Department of Surgery and Cancer, Imperial College London, St. Mary’s Campus, London, UK

    Ara Darzi

  3. Department of Otorhinolaryngology and Head & Neck Surgery, Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Trust, London, UK

    Bhik Kotecha

Authors
  1. Asit Arora
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  2. Konstantinos Chaidas
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  3. George Garas
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  4. Ashik Amlani
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  5. Ara Darzi
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  6. Bhik Kotecha
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  7. Neil S Tolley
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Corresponding author

Correspondence to Asit Arora.

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Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Comments

This interesting study analyzed outcomes of trans oral robotic surgery (TORS) in moderate and severe OSA who did not tolerate CPAP or oral appliance. This two year prospective pilot cohort study showed high rate of OSA cure without serious side effects. This study suggests the importance of tongue base on OSA pathophysiology.

We should however, take in mind that this small casuistic included no obese patients, they were overweight.

Obesity is well known the main risk factor for OSA contributing for several mechanisms of disease and if these TORS results might also occur for obese OSA patients have to be confirmed. There are different OSA phenotypes and it is very likely that every one needs an personalized management.

After the advent of positive pressure at the beginning of the 90’s, relatively few modalities of OSA treatment have showed up. Recognizing the OSA phenotype we will be able to identify the best management.

Sonia Maria Togeiro

São Paulo,Brazil

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Arora, A., Chaidas, K., Garas, G. et al. Outcome of TORS to tongue base and epiglottis in patients with OSA intolerant of conventional treatment. Sleep Breath 20, 739–747 (2016). https://doi.org/10.1007/s11325-015-1293-9

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  • DOI: https://doi.org/10.1007/s11325-015-1293-9

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