Endoscope-guided coblator tongue base resection using an endoscope-holding system for obstructive sleep apnea

Background: Multilevel obstruction in obstructive sleep apnea commonly includes retroglossal obstruction. To improve surgical success rates, tongue volume reduction with posterior midline glossectomy and/or lingual tonsillectomy is widely performed.

Methods: Nasotracheal intubation was utilized, and the combined tongue procedure was performed as a final step after palatal surgery. The tongue was pulled maximally by a retraction suture and a McIVOR (Karl Storz, Tuttlingen, Germany) or Davis mouth gag (Karl Storz,Tuttlingen, Germany), and a medium-length tongue blade was applied to expose the tongue base. A 70-degree rigid endoscope was fixed by the holding system and introduced into the oral cavity. Endoscope-guided coblator tongue base resection was then performed.

Results: The surgeon could use both hands for the surgery, enabling a more delicate resection of tongue base tissue.

Conclusion: This technique was acceptable and can be successfully used in patients with a large tongue, in whom exposing the tongue base for surgery is difficult.