Predictors of success in combination of tongue base resection and lateral pharyngoplasty for obstructive sleep apnea

The base of the tongue has been recognized as a significant site of obstruction in patients with obstructive sleep apnea (OSA). Our aim was to determine the independent predictors of surgical success in tongue base resection combined with lateral pharyngoplasty for OSA. Thirty-one OSA patients who underwent endoscopie-guided coblator or transoral robotic tongue base resection in combination with lateral pharyngoplasty for the treatment of retroglossal obstruction between March 2012 and December 2015 were enrolled in this study. Retroglossal obstruction was identified by preoperative nasopharyngoscopy with drug-induced sleep endoscopy and/or Muller's maneuver in supine position. Patients were divided into success and failure groups according to surgical outcome (postoperative apnea-hypopnea index (AHI) less than 20 and reduction more than 50% in baseline AHI). Physical profile, polysomnography, cephalometry parameters, and drug-induced sleep endoscopy and/or Muller's maneuver findings were compared between the two groups. Tonsil grade (p = 0.002), lateral oropharyngeal wall collapse on Muller's maneuver (p = 0.002), and AHI during rapid eye movement (REM AHI) (p = 0.038) were significantly higher in the success group than in the failure group. Tongue base collapse was more evident in the failure group than in the success group when patients open their mouth. (p = 0.037) Bigger tonsil size and higher REM AHI are favorable predictive factors, even in multilevel surgery such as tongue base resection, whereas tongue base collapse during mouth opening may be an unfavorable predictive factor.