Radiofrequency Surgery Treatment of Tongue Base Hypertrophy

Aggeli D.1, Stefanidis A.1, Triaridis A.1, Kynigou M.1, Xatziavramidis A.2,Sidiras T.1 1. E.N.T. Dpt, ‘Theagenion’ Anticancer Hospital, Thessaloniki2. E.N.T. Dpt, Papageorgiou General Hospital, Thessaloniki

LITERATURE1.Brendan A. et. al: Lingual tonsillectomy in a child with obstructive sleep apnea: a novel technique. Laryngoscope 116:668-669,

20062.Powell NB. et al: Radiofrequency tongue base reduction in sleep-disordered breathing: a pilot study. Otolaryngol Head Neck Surg

120:656-664, 19993.Elia J. Lingual tonsillitis. Ann N Y Acad Sci 82:52-56, 19594.Joseph M. et al: Lingual tonsillectomy: a treatment for inflammatory lesions of the lingual tonsil. Laryngoscope 94:179-184, 19845.Carr M. et al: Correlation of findings at direct laryngoscopy and bronchoscopy with gastroesophageal reflux disease in children: a

prospective study. Arch Otolaryngol Head Neck Surg 127:369-374, 20016.Uzochukwu N.O et al: Clear cell carcinoma of the base of the tongue: a case report. Am J Neuroradiol 28:127-128, 2007 7.Stuck B. et al: Volumetric tissue reduction in radiofrequency surgery of the tongue base. Otolaryngol Head Neck Surg 132:132-

135, 2005

The most common abnormality of the lingual tonsil is hyperplasia(1). Enlargement of the lingual tonsil or tongue base may cause narrowing of the hypopharynx, which may lead to obstruction of the upper airway, obstructive sleep apnea, changes of voice and dysphagia. Radiofrequency tissue reduction for the tongue base was introduced the last ten years as a minimally invasive treatment for the hypertrophic tongue base(2).

A 55 year-old-man who presented to his primary physician complaining of voice changes and sleep disturbance and he was diagnosed with tongue base mass. The patient was referred to our hospital for further evaluation. On physical examination a pale, soft mass was noted on the base of the tongue. He referred no allergies or other medical problems. He had tonsillectomy at his childhood. Hematologic and serum chemical laboratory indices were within normal limits with the exception of a prior CMV infection. Indirect laryngoscopy confirmed the presence of the mass of the base of the tongue. Two biopsies of the mass were performed with punch forceps under local anesthesia. Histology reported lemphadenoid tissue hyperplasia. Magnetic resonance imaging (M.R.I) was suggestive of a benign mass with no significant lemphadenopathy. Patient received under general anesthesia two treatment sessions with a single-needle radiofrequency device, within 3 months. The maximum power was set to 7 Watt. The post operative period was uneventful and the patient released 5 days after surgery. M.R.I examination was repeated 4 weeks after each session.

Introduction-purprose

Discussion-Conclusions

Material and methods

The lingual tonsil is lymphoid tissue located on the base of the tongue. It has no capsule. Although the lymphoid tissue of the Waldayer’s ring tends to diminish with age, the tissue of the lingual tonsil may increase in size. It is well known that a compensatory increase in the size of the lingual tonsil occurs in response to adenotonsillectomy(3). Allergy, alcohol, smokes and chronic infections are considered as possible etiologic factors of lingual tonsil hypertrophy(4). More recent studies correlate gastroesophageal reflux disease and enlargement of the lingual tonsil(5). The differential diagnosis for lingual tonsil hypertrophy includes ectopic thyroid tissue, lymphoma, hemangioma, squamus cell carcinoma, benign and malignant tumors of minor salivary gland origin and metastatic disease(6). The radiofrequency energy has been used to treat tonsillar hypertrophy in several ways; to completely remove, partly ablate or decrease the volume of enlarged tissue. In our case we used radiofrequency energy in order to reduce the hypertrophic lingual tonsil with a low bleeding risk and less discomfort for the patient. Radiological evaluation revealed inconsequential changes of the mass dimensions after the treatment although the patient was completely relived of his symptoms. It is possible that the beneficial effects of radiofrequency surgery of the tongue base are not based on volumetric changes but are more likely a result of changes in upper airway collapsibility as a result of the scarring of the tissue(7)

Results

Radiological evaluation showed insignificant change of the size of the mass after radiofrequency diathermy surgical treatment sessions. Nevertheless, the patient reported significant improvement of his symptoms. A month after the last session the patient was completely relieved of his symptom of sleep disturbance and his voice returned to normal

M.R.I four weeks after 1st radiofrequqncy sessio

M.R.I four weeks after 2nd fadiofrequency sessionM.R.I imaging before surgery