Tongue base suspension is a surgical procedure developed to address obstructive sleep apnea (OSA). The surgery is specifically designed for cases where the airway blockage is caused by the tongue. This procedure is often considered when other less invasive treatments have not been effective. Its goal is to create a more open airway during sleep, thereby reducing the health risks associated with OSA.
The Mechanics of Tongue Base Suspension
Obstructive sleep apnea often occurs when the genioglossus muscle, which makes up the bulk of the tongue, relaxes during sleep. This relaxation allows the tongue to fall backward due to gravity, blocking the passage of air in the pharynx. The procedure is considered minimally invasive and works by preventing the rear portion of the tongue from collapsing into the airway.
The technique involves the placement of a small titanium screw into the interior side of the lower jawbone, near the chin. This screw acts as a permanent anchor point. A non-dissolving suture is then looped through the muscle at the base of the tongue and attached to this anchor. This creates a sort of sling or hammock that cradles the tongue muscle, holding it in a forward position.
The tension on the suture is carefully adjusted to hold the tongue forward without affecting normal functions like speaking or swallowing. This stabilization of the tongue base is meant to ensure the airway remains open throughout the night.
Ideal Candidates for the Procedure
The procedure is generally reserved for patients diagnosed with moderate to severe obstructive sleep apnea. It is most often considered for individuals who have unsuccessfully tried or are unable to tolerate continuous positive airway pressure (CPAP) therapy, which is a primary non-surgical treatment for OSA.
A determining factor for candidacy is the specific cause of the airway obstruction. The surgery is only effective for patients whose apnea is predominantly caused by the tongue base collapsing backward. This is frequently accomplished through a diagnostic evaluation called Drug-Induced Sleep Endoscopy (DISE).
During a DISE procedure, the patient is sedated to simulate sleep, allowing the surgeon to use a flexible endoscope to directly observe the structures in the throat. This visualization reveals precisely where the airway is collapsing. If the endoscopy confirms that the primary site of obstruction is the base of the tongue, the patient may be considered a strong candidate for tongue base suspension.
The Surgical and Recovery Process
Tongue base suspension surgery is performed in a hospital or surgical center under general anesthesia, typically completed in about an hour. The surgeon makes a small and discreet incision underneath the chin to access the lower jawbone. Through this incision, the bone anchor is placed, and a specialized instrument is used to pass the suture through the tongue base muscle.
Once the suture is secured to the anchor and properly tensioned, the incision is closed. Because the entire procedure is performed through the small incision under the chin and inside the mouth, there are no visible external scars on the face. Patients are usually monitored for a short period after the surgery before being discharged.
A sore throat, swelling, and difficulty swallowing are common in the first few days to weeks following the procedure. To manage this and protect the healing tissues, patients are placed on a liquid or soft food diet for a period, typically lasting a few weeks. Most individuals can expect to return to work and other non-strenuous daily activities within one to two weeks, with a full return to normal function taking slightly longer.
Expected Results and Potential Complications
Success is often measured by a decrease in the Apnea-Hypopnea Index (AHI), which is the number of apnea (breathing stops) and hypopnea (shallow breathing) events per hour. A successful outcome leads to reduced snoring, improved sleep quality, and decreased daytime sleepiness. Studies have shown varied success rates, with some research indicating better results when the procedure is combined with other surgeries, such as a uvulopalatopharyngoplasty (UPPP).
As with any surgery, there is a risk of infection at the incision site. There is also a possibility of the suture loosening or breaking over time, which could cause the symptoms of OSA to return. Some patients may experience temporary or, in rare cases, persistent changes in swallowing or speech.
A thorough discussion with the surgeon about the potential benefits and drawbacks is a necessary step before proceeding with the surgery. Long-term follow-up is also part of the process to monitor the stability and effectiveness of the treatment.