This tonsils starting from foramen ceacum down to

This study was approved by the Institutional
Review Board. The study was prospectively conducted on 25 patients who
underwent transoral endoscopic coblation assisted tongue base resection for
management of moderate to severe OSAHS (AHI>15) with significant tongue base
hypertrophy at ENT department, Alexandria Main University hospitals between April and December 2017. Data registered
for the analysis were: age, sex, BMI, preoperative
AHI, operative time, intraoperative bleeding, volume of resected tongue base
tissues, postoperative AHI after at least 3 months, postoperative pain and complications
if any. Patients were excluded if they had severe cardiorespiratory co-morbidities
(ASA>3), morbidly obese patients (BMI>35),  patients had no significant tongue base
hypertrophy, patients with limited mouth opening allowing for transoral access
(inter-incisive distance less than 2.5cm). All patients were prepared and
draped for surgery in the sniffing position (neck flexed and head extended), exposure
of tongue base was achieved the same way used in TORS (stay silk suture in the
oral tongue to deliver tongue base, wide and short mouth gag blade was inserted
till level of circumvallate papillae to preserve taste sensation, the
Davis-Meyer mouth gag was suspended to ordinary Mayo stand as in Figure 1),
Then 45° up-looking endoscope was inserted in the mouth and kept in place using
endoscope-holder or by a third hand (the assistant). The coblation wand used in
resection is EVac 70 Xtra HP® that is used in tonsillectomy
operation as in figure 2. Starting resection by midline splitting of lingual
tonsils starting from foramen ceacum down to vallecula, and removal of each
side was done as separate specimen. Margins of lingual tonsils resections
include sulcus terminalis anterosuperiorly, amygdalo-glossus sulcus laterally,
glosso-epiglottic sulcus posteroinferiorly. If residual tongue muscles are
still obstructing the laryngeal inlet, coblation can be used to ablate those
residual tissues. Volume of resected tissues was measured by putting resected
tissues in a syringe filled with saline and measuring amount of fluid displaced
by resected specimen (Figures 3-5). 


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