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Radiological airway changes following bipolar radiofrequency volumetric tissue reduction

Published online by Cambridge University Press:  29 April 2010

R L Heywood
Affiliation:
Department of Otolaryngology, Queen's Hospital, Romford, UK
H M B Khalil
Affiliation:
Department of Otolaryngology, Queen's Hospital, Romford, UK
S Kothari
Affiliation:
Department of Otolaryngology, Queen's Hospital, Romford, UK
S Chawda
Affiliation:
Department of Radiology, Queen's Hospital, Romford, UK
B T Kotecha*
Affiliation:
Department of Otolaryngology, Queen's Hospital, Romford, UK
*
Address for correspondence: Mr Bhik Kotecha, Department of Otolaryngology, Queen's Hospital, Rom Valley Way, Romford RM7 0AG, UK. E-mail: [email protected]

Abstract

Objective:

To characterise the appearance of lesions of the tongue base and soft palate induced by bipolar radiofrequency volumetric tissue reduction, using magnetic resonance imaging up to six weeks post-procedure.

Methods:

Five men with sleep-disordered breathing were treated with one session of bipolar radiofrequency volumetric tissue reduction to a number of sites, including the tongue base and soft palate. Magnetic resonance imaging was performed pre-operatively and one week and six weeks after surgery.

Results:

Lesions were visible from day one. T1 (spine lattice relaxation Time)-weighted images demonstrated areas of central hyperintensity, reflecting haemorrhagic, coagulative necrosis, surrounded by hypointensity, representing oedema; corresponding short tau inversion recovery (STIR) sequences showed central hypointensity with surrounding high signal. The lesions expanded up to day three and then gradually diminished, but were still evident at week six on short tau inversion recovery images.

Conclusion:

The characterisation of lesions induced by bipolar radiofrequency volumetric tissue reduction enables us to elucidate the pathophysiology of this procedure, to optimise treatment benefits and clinical outcomes, and to explain patient symptoms.

Type
Main Articles
Copyright
Copyright © JLO (1984) Limited 2010

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References

1Schwab, RJ, Pasirstein, M, Pierson, R, Mackley, A, Hachadoorian, R, Arens, R et al. Identification of upper airway anatomic risk factors for obstructive sleep apnea with volumetric magnetic resonance imaging. Am J Respir Crit Care Med 2003;168:522–30CrossRefGoogle ScholarPubMed
2Powell, NB, Riley, RW, Guilleminault, C. Radiofrequency tongue base reduction in sleep-disordered breathing: a pilot study. Otolaryngol Head Neck Surg 1999;120:656–64CrossRefGoogle ScholarPubMed
3Powell, NB, Riley, RW, Troell, RJ, Blumen, MB, Guilleminault, C. Radiofrequency volumetric reduction of the tongue. A porcine pilot study for the treatment of obstructive sleep apnea syndrome. Chest 1997;111:1348–55CrossRefGoogle Scholar
4De Salles, AAF, Brekhus, SD, De Souza, EC, Behnke, E, Farahani, K, Anzai, Y et al. Early postoperative appearance of radiofrequency lesions on magnetic resonance imaging. Neurosurgery 1995;36:932–7CrossRefGoogle ScholarPubMed
5Powell, NB, Riley, RW, Troell, RJ, Li, K, Blumen, MB, Guilleminault, C. Radiofrequency volumetric tissue reduction of the palate in subjects with sleep-disordered breathing. Chest 1998;113:1163–74CrossRefGoogle ScholarPubMed
6Stuck, BA, Köpke, J, Hörmann, K, Verse, T, Eckert, A, Bran, G et al. Volumetric tissue reduction in radiofrequency surgery of the tongue base. Otolaryngol Head Neck Surg 2005;132:132–5CrossRefGoogle ScholarPubMed
7Stuck, BA, Maurer, JT, Verse, T, Hörmann, K. Tongue base reduction with temperature-controlled radiofrequency volumetric tissue reduction for treatment of obstructive sleep apnea syndrome. Acta Otolaryngol 2002;122:531–6CrossRefGoogle ScholarPubMed
8Young, GE, Sung, WK, Kee, HK, Jae, YB, Kun, HL. Single-session radiofrequency tongue base reduction combined with uvulopalatopharyngoplasty for obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol 2008;265:1495–500Google Scholar
9Pang, KP, Siow, JK. Sutter bipolar radiofrequency volumetric tissue reduction of palate for snoring and mild obstructive sleep apnoea: is one treatment adequate? J Laryngol Otol 2009;123:750–4CrossRefGoogle ScholarPubMed
10Baisch, A, Maurer, J, Hörmann, K, Stuck, BA. Combined radiofrequency assisted uvulopalatoplasty in the treatment of snoring. Eur Arch Otorhinolaryngol 2009;266:125–30CrossRefGoogle ScholarPubMed
11Yoruk, O, Akgun, M, Sutbeyaz, Y, Aktan, B, Ucuncu, H, Tatar, A et al. Treatment of primary snoring using modified radiofrequency-assisted uvulopalatoplasty. Eur Arch Otorhinolaryngol 2009;266:1807–14CrossRefGoogle ScholarPubMed
12Den Herder, C, Kox, D, van Tinteren, H, de Vries, N. Bipolar radiofrequency induced thermotherapy of the tongue base: its complications, acceptance and effectiveness under local anesthesia. Eur Arch Otorhinolaryngol 2006;263:1031–40CrossRefGoogle ScholarPubMed
13Lyons, MJ, Khalil, H, Kotecha, BT. Surgical approaches to the tongue base in patients requiring radiofrequency treatment for snoring. Clin Otolaryngol 2008;33:167–9CrossRefGoogle Scholar
14Tatla, T, Sandhu, G, Croft, CB, Kotecha, B. Celon radiofrequency thermo-ablative palatoplasty for snoring – a pilot study. J Laryngol Otol 2003;117:801–6CrossRefGoogle ScholarPubMed
15Stuck, BA, Köpke, J, Maurer, J, Verse, T, Eckert, A, Bran, G et al. Lesion formation in radiofrequency surgery of the tongue base. Laryngoscope 2003;113:1572–6CrossRefGoogle ScholarPubMed
16Khalil, HMB, Hewitt, R, Kotecha, B. Anatomical micro-dissection of hypoglossal nerve and its relation to radiofrequency thermotherapy. (Abstract) Clin Otolaryngol 2009;34(Suppl 1):64Google Scholar
17Khalil, HMB, Hannan, A, Kotecha, B. A prospective clinical study of tongue base application of bipolar radiofrequency induced thermotherapy for snoring and OSA. (Abstract) Clin Otolaryngol 2009;34(Suppl 1):63Google Scholar
18Steward, DL. Effectiveness of multilevel (tongue and palate) radiofrequency tissue ablation for patients with obstructive sleep apnea syndrome. Laryngoscope 2004;114:2073–84CrossRefGoogle ScholarPubMed
19Stuck, BA, Köpke, J, Maurer, JT, Verse, T, Kuciak, G, Düber, C et al. Evaluating the upper airway with standardized magnetic resonance imaging. Laryngoscope 2002;112:552–8CrossRefGoogle ScholarPubMed
20Trudo, FJ, Gefter, WB, Welch, KC, Gupta, KB, Maislin, G, Schwab, RJ. State-related changes in upper airway caliber and surrounding soft-tissue structures in normal subjects. Am J Respir Crit Care Med 1998;158:1259–70CrossRefGoogle ScholarPubMed
21Lauder, R, Muhi, ZF. Estimation of tongue volume from magnetic resonance imaging. The Angle Orthodontist 1991;61:175–84Google ScholarPubMed