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Radiofrequency ablation in snoring surgery: local tissue effects and safety measures

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Abstract

Radiofrequency ablation is now widely used in the treatment of patients with snoring and obstructive sleep apnoea. It is well suited to the multilevel approach typically required in snoring surgery and can be used interstitially or in cutting mode. However, no research has been performed to analyse the collateral local tissue damage or size of lesions induced by radiofrequency application. This is the first study of the histological effects of interstitial radiofrequency. We studied the size of tissue lesions generated at differing power settings with and without local anaesthetic application in human tonsils and chicken breast tissue. The size of the lesion was independent of power setting and local anaesthetic infiltration. The typical effect was an oval-shaped lesion centred on the active electrode, 6–7 mm in width and 7–8 mm in length. This was confirmed histopathologically, with smaller lesions generated in the submucosa (2 × 3 mm) but with no collateral tissue damage beyond this distinct zone of injury. To avoid complications, we recommend placing contiguous radiofrequency applications at least 8 mm apart. Post-nasal space packing raises and tautens the soft palate. The use of local anaesthetic increases interstitial volume, thereby reducing the risk of incorrect probe placement and resultant ulceration or fistulation.

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References

  1. Stuck BA (2009) Radiofrequency-assisted uvulopalatoplasty for snoring: long-term follow-up. Laryngoscope 119:1617–1620

    Article  PubMed  Google Scholar 

  2. Back LJ, Hytonen ML, Roine RP, Malmivaara AO (2009) Radiofrequency ablation treatment of soft palate for patients with snoring: a systematic review of effectiveness and adverse effects. Laryngoscope 119:1241–1250

    Article  PubMed  Google Scholar 

  3. Baisch A, Maurer JT, Hormann K, Stuck BA (2009) Combined radiofrequency assisted uvulopalatoplasty in the treatment of snoring. Eur Arch Otorhinolaryngol 266:125–130

    Article  PubMed  Google Scholar 

  4. Stimpson P, Kotecha B (2011) Histopathological and ultrastructural effects of cutting radiofrequency energy on palatal soft tissues: a prospective study. Eur Arch Otorhinolaryngol 268:1829–1836

    Article  PubMed  Google Scholar 

  5. Tatla T, Sandhu G, Croft CB, Kotecha B (2003) Celon radiofrequency thermo-ablative palatoplasty for snoring—a pilot study. J Laryngol Otol 117:801–806

    CAS  PubMed  Google Scholar 

  6. Kotecha B (2012) Evaluation of the upper airway in patients with snoring and OSA, sleep disorders. In: Idzikowski C (ed) Sleep disorders, Chapter 5(1st Ed), p 65–74. ISBN: 978-953-51-0293-9, InTech, Available from: http://www.intechopen.com/books/sleep-disorders/evaluation-of-the-upper-airway-in-patients-with-snoring-and-osa

  7. Georgalas C, Garas G, Hadjihannas E, Oostra A (2010) Assessment of obstruction level and selection of patients for obstructive sleep apnoea surgery: an evidence based approach. J Laryngol Otol 124:1–9

    Article  CAS  PubMed  Google Scholar 

  8. Back LJ, Liukko T, Sinokkonen ST, Ylikoski J, Makitie AA (2009) Complication rates of radiofrequency surgery in the upper airways: a single institution experience. Acta Otolaryngol 129:1469–1473

    Article  PubMed  Google Scholar 

  9. Virk JS, Nouraei R, Kotecha B (2013) Multilevel radiofrequency ablation to the soft palate and tongue base: tips and pitfalls. Eur Arch Otorhinolaryngol. doi:10.1007/s00405-013-2858-5

    PubMed  Google Scholar 

  10. Kang SS, Park JC, Yoon YJ, Shin KM (2012) Morphologic analysis of water-cooled bipolar radiofrequency on egg white in vitro. Korean J Pain 25:151–154

    Article  PubMed Central  PubMed  Google Scholar 

  11. Provenzano DM, Lutton EM, Somers DL (2012) The effects of fluid injection on lesion size during radiofrequency treatment. Reg Anesth Pain Med 37:267–276

    Article  CAS  PubMed  Google Scholar 

  12. Provenzano DA, Lassila HC, Somers D (2010) The effect of fluid injection on lesion size during radiofrequency treatment. Reg Anesth Pain Med 35:338–342

    Article  PubMed  Google Scholar 

  13. Provenzano DA, Liebert MA, Somers D (2013) Increasing the NaCl concentration of the preinjected solution enhances monopolar radiofrequency lesion size. Reg Anesth Pain Med 38:112–123

    Article  CAS  PubMed  Google Scholar 

  14. Kovoor P, Daly M, Mikhail M, Eipper V, Dewsnap B, Ross DL (2006) Change in size of lesions over 3 weeks after radiofrequency ablation of left ventricle. J Cardiovasc Electrophysiol 17:411–414

    Article  PubMed  Google Scholar 

  15. Kovoor P, Daly M, Campbell C, Dewsnap B, Eipper V, Uther J, Ross D (2004) Intramural radiofrequency ablation: effects of electrode temperature and length. Pacing Clin Electrophysiol 27:719–725

    Article  PubMed  Google Scholar 

  16. Nakagawa H, Yamanashi WS, Pitha JV et al (1995) Comparison of in vivo tissue temperature profile and lesion geometry for radiofrequency ablation with a saline-irrigated electrode versus temperature control in a canine thigh muscle preparation. Circulation 91:2264–2273

    Article  CAS  PubMed  Google Scholar 

  17. Petersen HH, Roman-Gonzalez J, Johnson SB et al (2004) Mechanisms for enlarging lesion size during irrigated tip radiofrequency ablation: is there a virtual electrode effect? J Interv Cardiol 17:171–177

    Article  PubMed  Google Scholar 

  18. Hammerschmitt N, Huber J, Farin G et al (2004) Effect of high frequency application on the tongue base. In vitro results of radiofrequency application on the porcine tongue base. HNO 52:18–24

    Article  CAS  PubMed  Google Scholar 

  19. Powell NB, Riley RW, Troell RJ, Blumen MB, Guilleminault C (1997) Radiofrequency volumetric reduction of the tongue. A porcine pilot study for the treatment of obstructive sleep apnea syndrome. Chest 111:1348–1355

    Article  CAS  PubMed  Google Scholar 

  20. Bran GM, Hunnebeck S, Herr RM, Hormann K, Stuck BA (2013) Bipolar radiofrequency volumetric tissue reduction of the inferior turbinates: evaluation of short-term efficacy in a prospective, randomized, single-blinded, placebo-controlled crossover trial. Eur Arch Otorhinolaryngol 270:595–601

    Article  PubMed  Google Scholar 

  21. Stelter K, Ihrler S, Siedek V, Patscheider M, Braun T, Ledderose G (2012) 1-year follow-up after radiofrequency tonsillotomy and laser tonsillotomy in children: a prospective, double-blind, clinical study. Eur Arch Otorhinolaryngol 269:679–684

    Article  PubMed  Google Scholar 

  22. Heywood RL, Khalil HM, Kothari S, Chawda S, Kotecha BT (2010) Radiological airway changes following bipolar radiofrequency volumetric tissue reduction. J Laryngol Otol 124:1078–1084

    Article  CAS  PubMed  Google Scholar 

  23. Stuck BA, Kopke J, Maurer JT et al (2003) Lesion formation in radiofrequency surgery of the tongue base. Laryngoscope 113:1572–1576

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. ENT Department, Queen’s Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK

    Jagdeep Singh Virk, Gaurav Kumar & Bhik Kotecha

  2. Histopathology Department, Queen’s Hospital, Romford, UK

    Dhafir Al-Okati

  3. ENT Department, Royal National Throat Nose and Ear Hospital, 330 Gray’s Inn Road, London, WC1X 8DA, UK

    Bhik Kotecha

Authors
  1. Jagdeep Singh Virk
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  2. Gaurav Kumar
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  3. Dhafir Al-Okati
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  4. Bhik Kotecha
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Correspondence to Bhik Kotecha.

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Virk, J.S., Kumar, G., Al-Okati, D. et al. Radiofrequency ablation in snoring surgery: local tissue effects and safety measures. Eur Arch Otorhinolaryngol 271, 3313–3318 (2014). https://doi.org/10.1007/s00405-014-3152-x

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  • DOI: https://doi.org/10.1007/s00405-014-3152-x

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