الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Obstructive sleep apnea (OSA) is a common but underestimated serious social health problem that is really challenging in its management.
CPAP remains the mainstay therapy. But unfortunately, patient’s compliance can be as low as 40% to 50% that the reason why surgical treatment may be an important alternative option to be considered.
To be successful, surgery should be properly selected and conducted, and most importantly, appropriate procedures must be tailored according to the specific demands of each patient. Understanding the sites of upper airways obstruction and its patterns is mandatory for surgical treatment decision-making and its efficiency.
Reviewing the findings of sleep endoscopy has showed that the cause of obstruction in the majority of OSA cases is hypertrophied tongue base. So that it must be well assessed preoperatively and cannot be overlooked.
The best approach for surgically addressing the base of tongue should be the widest, safest, and most functionally conservative because of the critical role of the tongue base in determining the quality of life of the patient.
Technological advances allowing improved access to the tongue base may theoretically allow for more tissue reduction with more delicate handling. Coblation assisted surgery has gained popularity in a number of fields in Otorhinolaryngology over the last two decades.
Coblation for tongue surgery in OSA has been used in different ways; midline posterior glossectomy, lingual tonsillectomy, submucosal minimally invasive lingual excision (SMILE), submucosal tongue body channeling, tongue base ablation, and resection.
The aim of this study was to assess the feasibility and efficacy of transoral endoscopic coblation tongue base surgery in the management of obstructive sleep apnea (OSA). Moreover, to compare using coblation in resection versus ablation of tongue base hypertrophy in moderate to severe OSA cases.
The study was conducted in Otolaryngology-Head & Neck Surgery Department; Alexandria Main University Hospital, Egypt. It comprised a two-year prospective comparative study of 50 patients undergoing surgery for their moderate to severe OSA with the main site of obstruction at the level of tongue base. Patients were randomly divided into 2 groups; group 1(CELL) and group 2(Robo-Cob). All data were registered regarding preoperative demographics, intraoperative findings, and postoperative outcome parameters.
In this study, the following results were found:
1. There were no statistically significant differences between the two studied groups as regards the patient’s age, sex, preoperative BMI, ESS, AHI, and NOHL findings in preoperative DISE.
2. Also, no statistically significant differences were observed between both groups regarding the eventual postoperative ESS and AHI levels.
3. On comparing pre and postoperative data, the two groups showed statistically significant clinical improvement in terms of ESS (subjective) and AHI (objective) reduction.
4. Surgical success rate was collectively 70%. In group A, it measured 68%, while in group B, it reached up to 72% without a statistically significant difference between both groups.
5. Robo-Cob was proved to be quicker than the CELL technique with an evident statistically significant difference in surgical tongue base time between both groups.
6. In the Robo-Cob group(B), volume measurement of the resected tissue specimen, allowed judging a satisfactory resection limit. It was found that resection of at least 10 cm3 of tongue base tissue was associated with a statistically significant better outcome in terms of postoperative AHI.
7. Presence of constant cooled saline irrigation kept tongue base tissues at the end of coblation surgery not warm with less tongue base edema, reduced liability to keep patient intubated at the end of surgery, early introduction of oral diet, and less postoperative pain.
8. No patients in our study developed life-threatening complications, all were self-limited and even minor events. No significant difference was detected in both groups concerning the postoperative pain score.