Radiofrequency ablation in snoring surgery: local tissue effects and safety measures

Uvulopalatopharyngoplasty with and without modified thyrohyoid suspension for obstructive sleep apnea treatment: a randomized clinical trial

PURPOSE

This study aims to compare the efficacy of Uvulopalatopharyngoplasty + Tongue Base Radiofrequency (TB-RF) and Uvulopalatopharyngoplasty + modified thyrohyoid suspension techniques + TB-RF which aimed to suspend base of tongue muscles anteriorly toward thyroid cartilage.

METHODS

This randomized controlled trial study was conducted on 48 cases of confirmed OSA between Jan, 2019 and Aug, 2022. We divided patients into two groups. One group underwent Uvulopalatopharyngoplasty + modified thyrohyoid suspension + TB-RF technique, and another one underwent Uvulopalatopharyngoplasty + TB-RF. Then, Apnea-Hypopnea Index (AHI), mean and lowest O2 saturation, Drug-Induced Sleep Endoscopy (DISE), Epworth Sleepiness Scale (ESS), Digit Symbol Substitution Test (DSST), Stanford Subjective Snoring Scale (SSSS), and T90 indexes were evaluated before and after each surgery.

RESULTS

The mean ± SD age was 39.4 ± 11.17 years. Of the 48 patients, 79.1% (n = 33) were male and 20.9% (n = 15) were female. AHI and SSSS in the Uvulopalatopharyngoplasty + modified thyrohyoid suspension group were significantly better than Uvulopalatopharyngoplasty group (P-value; 0.010). Though, there was no significant difference in terms of mean saturation, lowest desaturation, ESS, DSST, and T90 scores. The success rate in the Uvulopalatopharyngoplasty + modified thyrohyoid suspension and Uvulopalatopharyngoplasty groups, according to the Sher criteria: a minimum of 50% reduction with a final AHI less than 20, were 75% (18/24) and 41.7% (10/24), respectively. It was significantly higher in the Uvulopalatopharyngoplasty + modified thyrohyoid suspension group (P-value: 0.021).

CONCLUSION

The addition of modified thyrohyoid suspension technique to Uvulopalatopharyngoplasty have better surgical outcomes and more success rate than Uvulopalatopharyngoplasty in OSA patients.

TRIAL REGISTRATION

IRCT: IRCT20190602043791N2. https://en.irct.ir/trial/53365 .

Electrosurgery Turbinate Reduction Revisited: Can Comparable Volumetric Heating be Achieved Without Feedback Control?

BACKGROUND AND OBJECTIVES

Temperature-controlled radiofrequency inferior turbinate ablation (TCRFA) uses a feedback system to control thermal injury and achieve precise volumetric heating to induce specific scar formation. However, it requires costly single-use proprietary consumables. Comparable volumetric tissue heating may be achieved for a fraction of the cost by adjusting the power settings on traditional monopolar electrosurgery devices that use low-cost needle tips. This pre-clinical study aims to determine the optimized power parameters to achieve electrosurgical coagulum volume similar to that of TCRFA.

STUDY DESIGN/MATERIALS AND METHODS

An electrosurgery submucosal diathermy (SMD) system (cut mode, 4-32 W, 5-120 seconds) and a temperature-controlled radiofrequency ablation system (standard clinical parameters for treating inferior turbinate hypertrophy) were used to coagulate egg white and chicken breast. Coagulum major and minor axis were measured, and lesion volume was approximated as prolate spheroid.

RESULTS

No significant difference in volume was found between the temperature-controlled system and the electrosurgery system at 8 W for 30 seconds, 8 W for 60 seconds, 16 W for 30 seconds, 32 W for 5 seconds, and 32 W for 15 seconds. The time to achieve equivalent lesion size was significantly less in the SMD system when compared to the temperature-controlled system (P < 0.05).

CONCLUSION

Electrosurgery handpieces may achieve similar lesion volume effects as the temperature feedback-controlled, single-use handpieces when set to the optimized parameters. SMD handpieces are significantly more cost and time effective than proprietary devices, and they are easily used in the office. SMD devices may be a more affordable alternative to temperature-controlled systems with comparable lesion volume effect and may be valuable for office-based therapy. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

MinimallyInvasive Radiofrequency Surgery in Sleep-Disordered Breathing

Sleep-disordered breathing encompasses a spectrum of conditions ranging from simple snoring to obstructive sleep apnoea (OSA). Radiofrequency surgery represents a relatively new technique available to surgeons involved in managing this condition. Its principal advantage relates to its minimally invasive nature resulting in a reduced morbidity when compared to traditional sleep surgery. The presence of good-quality research evaluating the long-term outcomes is currently scarce, although the short-term data is promising. Careful patient selection appears to be paramount in obtaining a sustained improvement. The role of radiofrequency surgery in sleep-disordered breathing has been reviewed.

Plasma-Mediated Bipolar Radiofrequency Ablation of Overlong Soft Palate in the Dog: A Pilot Study

The objective of this study was to compare the clinical, biological, macroscopic, and histologic outcomes after resection of the soft palate by plasma-mediated bipolar radiofrequency ablation (PBRA) or traditional incisional techniques (incisional soft palate resection [INC]) in dogs. Ten dogs were divided in two groups. In the INC group, the soft palate was incised with scissors and the wound was sutured in a continuous pattern. In the PBRA group, a wand was used to ablate the desired portion of the soft palate, without suture. Clinical, biological, macroscopic, and histologic assessments were scheduled over 14 days. The duration of surgery was significantly shorter for the PBRA group. The C-reactive protein concentrations were significantly higher in the PBRA group at 6 hr and on day 3 (P < .05) but with values very close to the baseline. C-reactive protein concentrations were maximal, but with low values (<25 mg/L), at day 1 for both techniques. The irregularity scores for the soft palate caudal border on days 1, 3, and 14 were significantly higher in the INC group than in the PBRA group (P < .05). The main histopathologic changes were the presence of superficial granulomas and a significantly greater depth of tissue damage in the INC group (2.5 ± 0.3 mm) compared with the PBRA group (1.5 ± 0.1 mm; P < .05). PBRA compared favorably with the traditional technique in terms of ease, duration of surgery, and depth of tissue damage. Future studies are warranted to validate its effectiveness for treating brachycephalic airway obstruction syndrome in dogs.

When continuous positive airway pressure (CPAP) fails

Obstructive sleep apnoea (OSA) is increasingly prevalent, particularly in the context of the obesity epidemic, and is associated with a significant social, health and economic impact. The gold standard of treatment for moderate to severe OSA is continuous positive airway pressure (CPAP). However compliance rates can be low. Methodology to improve patient tolerance to CPAP alongside with alternative, non-surgical and surgical, management strategies are discussed. All patients that fail CPAP therapy would benefit from formal upper airway evaluation by the otolaryngologist to identify any obvious causes and consider site-specific surgical therapies. Patient selection is integral to ensuring successful outcomes. A multidisciplinary team is needed to manage these patients.

The treatment of snoring by radiofrequency-assisted uvulopalatoplasty and results after one-session protocol: a prospective, longitudinal, non-randomized study

Snoring is usually caused by the vibration of walls of the soft palate at the pharyngeal level. Its worldwide prevalence is estimated to range between 2 and 85% depending on age, gender or population group. The aim of this study is to determine the degree of improvement that can be subjectively evident in patients treated by snoring with radiofrequency-assisted uvulopalatoplasty based on a one-session protocol. This is a prospective, longitudinal, non-randomized study. Patients of both sexes, aged 18 years, who attended to the ENT consultation in a tertiary hospital with snoring during the period of July 2012-July 2013 were included. Age, body mass index, Epworth sleepiness scale were calculated. The volume of snoring of each subject was assessed using a visual analog scale. A total of 27 patients were included in the study; the average age of the sample was 49 years (±8.7; min 36/max 74); of these 22 (81.5%) were male and 5 (18.5%) females. The average BMI was 27.07 ± 2.5 (min 23.15/max 29.39) before the test and after 1 year was 26.75 ± 2.32 (min 23.11/max 29.56) with no statistically significant differences in BMI before and after surgery (p = 0.407). Preoperative snoring intensity was 8.10 ± 0.93 according to VAS. We found a statistically significant difference in the post-operative intensity at 3 months of 3.93 ± 0.88 (p ≤ 0.05) at 6 months of 4.41 ± 1.08 (p ≤ 0.05), and after 1 year 4.90 ± 0.77 (p ≤ 0.05). The average rate of ESS was significantly higher preoperatively than post-operative, being 8.76 ± 3.1 preoperative and 6.93 ± 1.68 post-operative (p ≤ 0.05). We conclude that the use of radiofrequency in simple snorers with an apnea/hypopnea index <15 events per hour and a BMI < 30 kg/m(2) in whom clinically proven that the source of snoring is the soft palate, can be treated by one-session protocol, being possible to obtain an improvement of snoring up to 70% of cases by a short follow-up period.