Base of Tongue Surgery



Coblation tongue surgery and trans-oral robotic surgery (TORS) proved to be the most used therapeutic options for the surgical treatment of patients affected by obstructive sleep apnea-hypopnea syndrome (OSAHS) secondary to hypopharyngeal collapse. A systematic review of the literature and an analysis of the techniques are presented in this chapter. The mean rates of failure were 34.4% and 38.5%, respectively, in TORS and Coblation groups. Complications occurred in 21.3% of the patients treated with TORS and in 8.4% of the patients treated with Coblation surgery. TORS seems to give slightly better results, allowing a wider surgical view and a measurable, more consistent removal of lingual tissue. However, the higher rate of minor complication and the significant costs of TORS must also be considered. Moreover, both technologies may be applied to a wide range of surgical techniques, each of them with different effectiveness.


Coblation Trans-oral robotic surgery Tongue base Technology OSAHS 


  1. 1.
    Campanini A, Canzi P, De Vito A, Dallan I, Montevecchi F, Vicini C. Awake versus sleep endoscopy: personal experience in 250 OSAHS patients. Acta Otorhinolaryngol Ital. 2010;30(2):73–7.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Vicini C, Dallan I, Canzi P, Frassineti S, La Pietra MG, Montevecchi F. Transoral robotic tongue base resection in obstructive sleep apnoea-hypopnoea syndrome: a preliminary report. ORL J Otorhinolaryngol Relat Spec. 2010;72(1):22–7.CrossRefGoogle Scholar
  3. 3.
    He M, Chen H, Jin W, He Y, Su Z, Fan Y, Yu C. Uvulopalatopharyngoplasty and tongue base coblation treat the 112 cases of severe obstructive sleep apnea-hypopnea syndrome. Lin Chuang Er Bi Yan Hou Ke Za Zhi. 2005;19(23):1061.PubMedGoogle Scholar
  4. 4.
    Cammaroto G, Montevecchi F, D’Agostino G, Zeccardo E, Bellini C, Galletti B, Shams M, Negm H, Vicini C. Tongue reduction for OSAHS: TORSs vs coblations, technologies vs techniques, apples vs oranges. Eur Arch Otorhinolaryngol. 2017;274(2):637–45.CrossRefGoogle Scholar
  5. 5.
    Friedman M, Hamilton C, Samuelson CG, Kelley K, Taylor D, Pearson-Chauhan K, Maley A, Taylor R, Venkatesan TK. Transoral robotic glossectomy for the treatment of obstructive sleep apnea-hypopnea syndrome. Otolaryngol Head Neck Surg. 2012;146(5):854–62.CrossRefGoogle Scholar
  6. 6.
    Hoff PT, D’Agostino MA, Thaler ER. Transoral robotic surgery in benign diseases including obstructive sleep apnea: safety and feasibility. Laryngoscope. 2015;125(5):1249–53.CrossRefGoogle Scholar
  7. 7.
    Vicini C, Montevecchi F, Campanini A, Dallan I, Hoff PT, Spector ME, Thaler E, Ahn J, Baptista P, Remacle M, Lawson G, Benazzo M, Canzi P. Clinical outcomes and complications associated with TORS for OSAHS: a benchmark for evaluating an emerging surgical technology in a targeted application for benign disease. ORL J Otorhinolaryngol Relat Spec. 2014;76(2):63–9.CrossRefGoogle Scholar
  8. 8.
    Toh ST, Han HJ, Tay HN, Kiong KL. Transoral robotic surgery for obstructive sleep apnea in Asian patients: a Singapore sleep centre experience. JAMA Otolaryngol Head Neck Surg. 2014;140(7):624–9.CrossRefGoogle Scholar
  9. 9.
    Muderris T, Sevil E, Bercin S, Gul F, Kiris M. Transoral robotic lingual tonsillectomy in adults: preliminary results. Acta Otolaryngol. 2015;135(1):64–9.CrossRefGoogle Scholar
  10. 10.
    Hoff PT, Glazer TA, Spector ME. Body mass index predicts success in patients undergoing transoral robotic surgery for obstructive sleep apnea. ORL J Otorhinolaryngol Relat Spec. 2014;76(5):266–72.CrossRefGoogle Scholar
  11. 11.
    Lin HS, Rowley JA, Folbe AJ, Yoo GH, Badr MS, Chen W. Transoral robotic surgery for treatment of obstructive sleep apnea: factors predicting surgical response. Laryngoscope. 2015;125(4):1013–20.CrossRefGoogle Scholar
  12. 12.
    Thaler ER, Rassekh CH, Lee JM, Weinstein GS, O’Malley BW Jr. Outcomes for multilevel surgery for sleep apnea: obstructive sleep apnea, transoral robotic surgery, and uvulopalatopharyngoplasty. Laryngoscope. 2016;126(1):266–9.CrossRefGoogle Scholar
  13. 13.
    MacKay SG, Carney AS, Woods C, Antic N, McEvoy RD, Chia M, Sands T, Jones A, Hobson J, Robinson S. Modified uvulopalatopharyngoplasty and coblation channeling of the tongue for obstructive sleep apnea: a multi-centre Australian trial. J Clin Sleep Med. 2013;9(2):117–24.CrossRefGoogle Scholar
  14. 14.
    Hou T, Hu S, Jiang X. Tongue coblation via the ventral approach for obstructive sleep apnea-hypopnea syndrome surgery. Laryngoscope. 2012;122(11):2582–6.CrossRefGoogle Scholar
  15. 15.
    Wang L, Liu JX, Yang XL, Yang CW, Qin YX. Z-palatoplasty and tongue radiofrequency for patients with small tonsils. Otolaryngol Head Neck Surg. 2013;148(5):873–7.CrossRefGoogle Scholar
  16. 16.
    Wee JH, Tan K, Lee WH, Rhee CS, Kim JW. Evaluation of coblation lingual tonsil removal technique for obstructive sleep apnea in Asians: preliminary results of surgical morbidity and prognosticators. Eur Arch Otorhinolaryngol. 2015;272(9):2327–33.CrossRefGoogle Scholar
  17. 17.
    Li HY, Lee LA, Kezirian EJ. Coblation endoscopic lingual lightening (CELL) for obstructive sleep apnea. Eur Arch Otorhinolaryngol. 2016;273(1):231–6.CrossRefGoogle Scholar
  18. 18.
    Babademez MA, Ciftci B, Acar B, Yurekli MF, Karabulut H, Yilmaz A, Karasen RM. Low-temperature bipolar radiofrequency ablation (coblation) of the tongue base for supine-position-associated obstructive sleep apnea. ORL J Otorhinolaryngol Relat Spec. 2010;72(1):51–5.CrossRefGoogle Scholar
  19. 19.
    Friedman M, Soans R, Gurpinar B, Lin HC, Joseph N. Evaluation of submucosal minimally invasive lingual excision technique for treatment of obstructive sleep apnea/hypopnea syndrome. Otolaryngol Head Neck Surg. 2008;139(3):378–84; discussion 385.CrossRefGoogle Scholar
  20. 20.
    Li D, Zhang Q, Song W. A retrospective study of 768 coblation treatment in children with obstructive sleep apnea-hypopnea syndrome. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2014;28(7):453–4, 458.PubMedGoogle Scholar
  21. 21.
    Torre C, Camacho M, Liu SY, Huon LK, Capasso R. Epiglottis collapse in adult obstructive sleep apnea: a systematic review. Laryngoscope. 2016;126(2):515–23.CrossRefGoogle Scholar
  22. 22.
    Parker NP, Walner DL. Post-operative pain following coblation or monopolar electrocautery tonsillectomy in children: a prospective, single-blinded, randomised comparison. Clin Otolaryngol. 2011;36(5):468–74.CrossRefGoogle Scholar
  23. 23.
    Thottam PJ, Govil N, Duvvuri U, Mehta D. Transoral robotic surgery for sleep apnea in children: is it effective? Int J Pediatr Otorhinolaryngol. 2015;79(12):2234–7.CrossRefGoogle Scholar
  24. 24.
    Lin AC, Koltai PJ. Persistent pediatric obstructive sleep apnea and lingual tonsillectomy. Otolaryngol Head Neck Surg. 2009;141(1):81–5.CrossRefGoogle Scholar
  25. 25.
    Maturo SC, Mair EA. Submucosal minimally invasive lingual excision: an effective, novel surgery for pediatric tongue base reduction. Ann Otol Rhinol Laryngol. 2006;115(8):624–30.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Head and Neck Department, ENT and Oral Surgery UnitG.B. Morgagni—L. Pierantoni Hospital, Forlì, Infermi HospitalFaenzaItaly

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