Transsubmental tongue-base suspension in treating patients with severe obstructive sleep apnoea after failed uvulopalatopharyngoplasty: our experience.

Dear Editor, Snoring and obstructive sleep apnoea is largely owing to narrowed upper airway and abnormal collapsibility during sleep. More than 90% of apneic patients have single obstruction in the retropalatal level, whereas 40–50% of those have obstruction in multiple sites, including retropalatal space, retrolingual space and hypopharynx. Successful surgical management of obstructive sleep apnoea requires various procedures to address these multiple levels of airway obstruction. Although uvulopalatopharyngoplasty is commonly performed in treating snoring or obstructive sleep apnoea patients, the success rate of uvulopalatopharyngoplasty is as low as 5–10% in severe obstructive sleep apnoea patients with retrolingual obstruction. Traditional tongue-base suspension with Repose System (Metronic Xomed, Jacksonville, FL, USA), first described by DeRowe et al., is a minimally invasive surgery to prevent retrolingual collapse during sleep. However, the effectiveness of tongue-base suspension in treating severe obstructive sleep apnoea patients with failed uvulopalatopharyngoplasty remains unexplored. Additionally, traditional tongue-base suspension with the transoral approach causes significant postoperative morbidity, e.g., teeth numbness, sialoadenitis, sublingual hematoma and sublingual gland obstruction. The aim of this study is to investigate the role of newly designed transsubmental tongue-base suspension in treating severe obstructive sleep apnoea patients while uvulopalatopharyngoplasty has failed. Exactly how the sleep position affects the efficacy of transsubmental tongue-base suspension is also analysed. Patients and methods