Tongue Surgery to Cure Sleep Apnoea - Trans-Oral Robotic Surgery

Am sat here right now with 5 stitches in my own tongue from a biopsy I had a 5 days ago, and after this experience, nobody is coming near my tongue!  However, the following article is a testimony of one man's experience of how it cured his sleep apnoea.  I'd like to know if he has had a sleep study done since the surgery though, as he does say he's still snoring a little. 

"Around 120,000 Britons suffer from sleep apnoea, where snorers stop breathing in the night.

Anthony Baker, 70, a retired company director from Thames Ditton, Surrey, had a new treatment for the condition.

THE PATIENT

'I did feel exhausted a lot of the time, but I just put it down to ageing,' said Anthony Baker

My snoring has driven people mad over the years.

One of the worst times was when I caught a sleeper train in Australia  — and kept half the carriage awake, apparently.

My partner, June, is a light sleeper and hates my snoring — so much so that I was relegated to the spare room a few years ago.

It started in my 40s and over the years I’ve tried gadgets such as nasal strips to improve airflow, but nothing has ever helped.

Then, about six years ago, June said I’d started making really strange noises in my sleep.

She said it was as though I had stopped breathing and was gasping for air.

Looking back, I did feel exhausted a lot of the time, but I just put it down to ageing.

I also blamed my age for the fact I was having memory problems. Sometimes I would leave the house and forget where I was going.

June was so worried about the noises I was making while asleep that I decided to see my GP.

Two years ago, I was diagnosed with obstructive sleep apnoea, where you stop breathing while asleep and wake up to kick-start your breathing again.

In my case, my tongue was flopping back in my throat when I was asleep, blocking my airway so I couldn’t breathe.

My specialist, Mr Kotecha, explained my memory problems could have been caused by the lack of oxygen to my brain, which was effectively causing it to malfunction.

The lack of oxygen also increased my risk of high blood pressure, diabetes and heart disease, which was worrying.

By coincidence, at the time I was diagnosed, Mr Kotecha said he and a colleague were trialling a type of robotic surgery they thought would be suitable for me.

It would cut away some of my tongue so even if it did flop to the back of my throat during the night, it wouldn’t be bulky enough to block my airway. I jumped at the chance.

Mr Kotecha explained he would do three things: take off a bit of my epiglottis — located behind the tongue — so it wouldn’t vibrate so much, which is what was causing the snoring.

He would also shave a bit off my tongue to make my airway bigger so it couldn’t get obstructed when I was asleep.

Lastly, he would remove some of the top of my mouth, again to make the airway bigger

He said that until now, it had been almost impossible to do the operation manually, which is why the robot was so exciting.

I had the operation a year ago at St Mary’s Hospital, London. It took a couple of hours and when I woke up from the anaesthetic I wasn’t in pain.

Because it’s a new procedure — I was the third person in the country to have the op — I stayed in for two nights. It took a couple of weeks for everything to settle down.

Now I sleep eight hours straight and I’m less tired. I still snore a bit, but it’s not nearly as bad.

My memory hasn’t got any worse. I’m still in the spare room, but hope I’ll be allowed back eventually.

THE SURGEON

Mr Bhik Kotecha is a consultant surgeon at The Royal National Throat, Nose and Ear Hospital, London.

Around 40 per cent of the adult population are snorers and 10 per cent of these have some degree of sleep apnoea.

There are two forms — obstructive sleep apnoea is the most common.

This is where an obstruction — perhaps the tonsils, the tongue flopping back in the throat or nasal polyps — blocks the airway.

Sometimes the obstruction is caused by the muscles and soft tissues in the throat relaxing and collapsing so much that they cause a total blockage.

There is another form — central sleep apnoea, where the brain effectively forgets to tell the lungs to breathe, but this is rare.

One of the key symptoms of obstructive sleep apnoea is snoring, but what is worse is that the patient stops breathing.

The lack of oxygen causes them to wake up in order to restore normal breathing. As a result, sleep can be fragmented.

Sufferers often feel exhausted and may have a morning headache.

Men are twice as likely to suffer as women. That’s because they are more likely to store excess weight around the neck, which puts extra pressure on the tissues so they are more likely to collapse.

Women also have higher levels of the hormone oestrogen, which protects against sleep apnoea.

Under-diagnosis is a problem. Many people assume they are simply snorers when sleep apnoea is the cause of the snoring.

And there are serious medical implications. Because it deprives the body of oxygen, the condition increases the chance of heart disease, high blood pressure, stroke and type 2 diabetes. Memory and concentration can also be impaired.

The good news is that GPs are increasingly aware of the condition. 

The condition is diagnosed with a sleep study and the recommended treatment is continuous positive airway pressure (CPAP).

A mask connected to a machine blows air into the throat, keeping the airway open — but drop-out rates are high.

In terms of surgery, until now it has been difficult to access the base of the tongue.

But a new robotic technique pioneered in the U.S. means we have 360 degree access to the area and a 3D view. 

My colleagues and I at St Mary’s are now performing it in the UK.

Called trans-oral robotic surgery, it uses a laser to cut away about 10 per cent of the back of the tongue.

It is suitable for those with moderate to severe sleep apnoea and patients who cannot tolerate CPAP.

They must have a body mass index under 35, as fat around the neck will affect the success of the procedure.

We use a very precise machine called the Da Vinci robot — better known for its use in prostate cancer surgery.

We put its three tiny arms inside the patient’s mouth.

One holds a telescope, so we can see what we’re doing, another holds the laser to cut away part of the tongue and tissue, and the final arm holds forceps to remove excess matter or manipulate the tissue.

The laser shaves off the top layer of the back of the tongue. It works at 300 degrees Celsius and seals  the blood vessels as it goes, so  there should be no bleeding. The procedure takes around two hours.

As with any operation, there is the risk of infection, but this is small.

Patients may find it painful to swallow after the operation — we advise soft food for the first 48 hours.

We have a success rate of 80 per cent. I am delighted Mr Baker has benefited from the surgery.

The operation costs £12,000 to £15,000 and is available on the NHS, or privately at the Princess Grace Hospital in London."

Article: http://www.dailymail.co.uk/health/article-2127411/Want-stop-snoring...