Stanford Sleep Surgery

Tongue Surgery

Most sleep specialists agree that in a significant number of adult patients, obstruction in the area behind the tongue play an important role in OSA. Current data suggest that in some patients better outcomes are achieved by surgically targeting this area in addition to the nasal cavity and palate. Surgical procedures can be designed to make the tongue firmer and less collapsible during sleep, or can be used to remove tongue tissue, and therefore reducing its volume in some cases. As with any other technique careful patient evaluation is key for achieving good results.

Trans-oral Robotic Surgery for Obstructive Sleep Apnea

The tongue is considered to play a significant role in upper airway blockage during sleep in a number of obstructive sleep apnea sufferers. Particularly in those who have an enlarged tongue base secondary to lymphatic tissue, usually called lingual tonsils, targeting this area may offer additional obstruction relief and improvement in surgical success.

The challenging aspect of this procedure is how to reach and adequately see the operative field. The main advantages of the robotic assisted surgery use are its improved precision, visualization and delicate tissue handling. In this procedure, the surgeon commands small instruments through a console, and has improved vision through large screens.

This procedure is usually performed in combination with palatal interventions, approach commonly termed “multiple level surgery”, as it handles all locations, the palate, lateral pharyngeal walls, tonsils and tongue. Current data suggests that combined interventions have improved outcomes when compared with palatal surgery in isolation in select patients.

Genioglossus Advancement

A surgical procedure where the tongue muscle that is attached to the lower jaw is pulled forward, making the tongue firmer and less collapsible during sleep. In this procedure, a small window of bone is made in the lower jaw, and the piece of bone along with the attachment for the tongue is pulled forward and fixed by a small screw or a plate in the external bone surface.

Genioglossus advancement: frontal view

Genioglossus advancement: sagital view