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Original Investigation |

Efficacy of Coblation Endoscopic Lingual Lightening in Multilevel Surgery for Obstructive Sleep Apnea

Hsueh-Yu Li, MD1,2; Li-Ang Lee, MD1; Eric J. Kezirian, MD, MPH3
[+] Author Affiliations
1Sleep Center, Department of Otorhinolaryngology–Head and Neck Surgery, Linkou-Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, Republic of China
2Department of Sleep Medicine, Royal Infirmary Edinburgh, Edinburgh, Scotland
3USC Tina and Rick Caruso Department of Otolaryngology–Head and Neck Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles
JAMA Otolaryngol Head Neck Surg. 2016;142(5):438-443. doi:10.1001/jamaoto.2015.3859.
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Importance  Multilevel obstruction is involved in the pathogenesis of obstructive sleep apnea (OSA). Coblation endoscopic lingual lightening (CELL) is a variation of glossectomy to reduce tongue collapse and can be considered in the surgical management of adults with OSA.

Objective  To evaluate the clinical and polysomnographic outcomes of tongue base reduction using CELL in multilevel surgery for OSA.

Design, Setting, and Participants  A retrospective case-control study was performed to review the medical records of adults with OSA (apnea-hypopnea index [AHI], >20) and Friedman stage III (tongue position III and tonsil size I-II) who underwent combined CELL and relocation pharyngoplasty (group 1) or relocation pharyngoplasty alone (group 2) for OSA between January 1, 2012, and December 31, 2013, at a tertiary referral sleep center. The groups were matched by age, sex, body mass index, and AHI at baseline. The dates of the analysis were May 30 to June 29, 2014.

Intervention  Coblation endoscopic lingual lightening.

Main Outcomes and Measures Methods  The primary outcome measure was change in AHI after surgery (after ≥6 months). Other outcomes were differences in surgical response rates, perioperative apnea index, lowest oxygen saturation, and Epworth Sleepiness Scale score.

Results  The study cohort comprised 90 participants. Their mean (SD) age was 40.7 (9.2) years, and 96% (86 of 90) were male. Group 1 patients (n = 30) underwent combined CELL and relocation pharyngoplasty, and group 2 patients (n = 60) underwent relocation pharyngoplasty only. The mean (SD) AHI decreased from 48.4 (16.9) to 16.5 (11.2) (P < .001) in group 1 and from 44.2 (19.3) to 20.1 (15.6) (P < .001) in group 2 . Percentage change in AHI was significantly different between group 1 and group 2 (mean [SD], −65.5 [20.5] vs −53.2 [30.3]) (P = .047). The surgical response rate was greater in group 1 (73% [22 of 30]) than in group 2 (50% [30 of 60]) (P = .04).

Conclusions and Relevance  Without increasing complications, combined CELL and relocation pharyngoplasty achieved greater AHI reduction and a higher surgical response rate among adults with OSA and Friedman stage III compared with relocation pharyngoplasty alone.

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Figure 1.
A Scenario of Coblation Endoscopic Lingual Lightening (CELL)

A, The surgeon is shown performing CELL using videoendoscopic guidance (modified from Li et al13 with permission). B and C, CELL involves submucosal debulking of the tongue body (B) and open ablation of the tongue base (C).

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Figure 2.
Comparison of Change in Apnea-Hypopnea Index (AHI) Between the 2 Groups Before and After Surgery

The AHI reduction in group 1 (combined coblation endoscopic lingual lightening and relocation pharyngoplasty) was significantly higher than that in group 2 (relocation pharyngoplasty only). The mean (95% CIs) are shown.

aP < .05.

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