Endoscopic Assisted Coblation Lingual Tonsillectomy: Our Experience in Selected Cases with Obstructive Sleep Apnea

Abstract Background: Obstructive Sleep apnea (OSA) is a disorder characterized by frequent cessation of breathing (apnea) and or shallow breathing (hypopnea) during sleep. Multilevel obstructions, including both retropalatal and retrolingual obstructions, are usually identified in more than half of the OSA patients. Aim of Study: The importance of tongue base hypertrophy in OSA is now clear. Butsurgery remains challenging. This study aimed to report our results in the assessment of lingual tonsillectomy by coblation for the management of tongue base hypertrophy in patients with moderate to severe OSA. Patients and Methods: This prospective study was con-ducted between 2019 and 2021 on patients with moderate to severe OSA with retro-lingual collapse that was confirmed by awake and drug induced sleep endoscopy (DISE). Endo-scopic assisted coblation lingual tonsillectomy (EACLT) was performed for all patients in combination with other palatal and/or nasal surgeries. Preoperative and 3 to 6 months after surgery, all patients underwent polysomnography and Epworth Sleepiness Scale (ESS), and values were assessed. Results: Within the included 24 patients, the mean apnea hypopnea index (AHI) dropped significantly (p<0.001) from 46.87±15.86 preoperatively to 19.30±13.42 postoperatively. Successful outcome was reported in 16 patients (66.7%). The mean oxygen desaturation index (ODI) decreased from 43.41±  14/h to 19.93±13.7/h (p<0.001). The mean minimal oxygen saturation (SaO2) increased from 77.46±11.01% to 86.22±  9.46% (p<0.001). Two patients (8.3%) developed delayed postoperative bleeding from the tonsillar bed. Oth-erwise, no significant intra or postoperative complications were reported. No patients developed tongue oedema or required ICU admission. Conclusions: EACLTappears a safe and effective method for addressing lymphatic tongue base hypertrophy in patients with OSA with minimal side effects.