Radiofrequency tongue reduction through a cervical approach: a pilot study

The objective of this prospective cohort study was to determine the feasibility, safety, and efficacy of radiofrequency tongue base reduction through a cervical approach in patients with obstructive sleep apnea syndrome (OSAS).

Patients with moderate to severe OSAS and predominant tongue base obstruction by physical examination were included at our institution from 1999 to 2003. A sonogram was obtained to identify the lingual arteries, and an electrode was inserted through the neck and into the tongue under fluoroscopic guidance. Adverse events were recorded as well as efficacy on snoring (visual analog scale), daytime sleepiness (Epworth score), and polysomnography.

The 10 patients received a mean of 14,288 +/- 3,251 J per session. No cases of tongue palsy or infection occurred. During the first 7 days, mean pain score (0-10 scale) was 1.3 +/- 1.5. Snoring volume (0-10 scale) decreased from 6.2 +/- 2.3 to 3.9 +/- 2.6 (P = .017) and sleepiness (0-24 scale) from 8.7 +/- 5.6 to 4.7 +/- 3.3 (P = .011). The respiratory disturbance index (events/hour) decreased from 52.0 +/- 19.6 to 33.6 +/- 24.4 (P = .016). Mean minimal oxygen saturation (%) increased from 64.2 +/- 13.0 to 75.8 +/- 10.3 (P = .003). Sleep architecture improved although not significantly.

Radiofrequency tongue base reduction through a cervical approach proved feasible and safe despite the large energy doses used. Fluoroscopic guidance enables to place the electrode at the desired site of treatment. Although OSAS improved in nine of 10 patients, greater efficacy might be achieved in patients with less severe OSAS at baseline. Studies are needed to correlate objective clinical efficacy with the dose per lesion site and the number of lesion sites per session.