• Song-Tar Toh, Hong-Juan Han, Hin-Ngan Tay, and Kimberley Li-Qin Kiong.
• Sleep Apnea Surgery Service, Department of Otolaryngology, Singapore General Hospital, Singapore2School of Medicine, National University of Singapore, Singapore3Duke-National University of Singapore Graduate School of Medicine, Singapore.
• JAMA Otolaryngol Head Neck Surg. 2014 Jul 1;140(7):624-9.

ImportanceThis study investigates the effectiveness of combined palatal surgery and transoral robotic surgical (TORS) tongue base reduction with partial epiglottidectomy in the treatment of obstructive sleep apnea (OSA) in an Asian context. To our knowledge, this is the first report on TORS for OSA in Asian patients in the literature.ObjectiveTo report our preliminary experience with combined TORS tongue base reduction and partial epiglottidectomy with palatal surgery as a multilevel surgical treatment strategy for moderate to severe OSA in Asian patients for whom positive airway pressure treatment had failed.Design, Setting, And ParticipantsA retrospective study of prospectively collected data on 40 Asian patients who underwent primary TORS tongue base reduction with partial epiglottidectomy and palatal surgery for treatment of moderate to severe OSA at an academic tertiary surgical center.InterventionsTransoral robotic surgery and palatal surgery for surgical management of OSA in patients for whom positive airway pressure treatment had failed.Main Outcomes And MeasuresTwenty patients with complete preoperative and postoperative overnight polysomnograms were evaluated for surgical success and cure, according to traditional surgical criteria, and for subjective outcome measures (snoring and satisfaction on visual analog scale [VAS] and Epworth Sleepiness Scale [ESS]) as well as complications.ResultsTraditional cure (apnea-hypopnea index [AHI] <5/h) was achieved in 7 of 20 patients (35%), traditional success (AHI <20 [>50% reduction in AHI]) was achieved in another 11 patients (55%), and failure was observed in 2 patients (10%). Subjective improvement in snoring, satisfaction, and ESS score was observed. Improvement in mean (SD) ESS score and snoring loudness on VAS were statistically significant, from 12.4 (2.87) to 6.4 (1.43) and 8.7 (0.8) to 3.5 (1.7), respectively (P < .001 for both). None of the patients needed postoperative tracheostomy. Recorded complications included tonsillar fossa bleeding, pain, temporary dysgeusia, numbness of the tongue, and temporary dysphagia.Conclusions And RelevanceTransoral robotic surgery for tongue base reduction and partial epiglottidectomy for moderate to severe OSA in Asian patients for whom positive airway pressure treatment had failed is associated with good efficacy and low complication rates.

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