Lingual Tonsillectomy

Lingual tonsillectomy is performed on patients with moderate to severe obstructive sleep apnea. Patients are initially evaluated in the office and then proceed to diagnostic sleep endoscopy to confirm the site(s) of obstruction at the base of the tongue. The tissue that typically causes this collapse is called the lingual tonsil. The lingual tonsils sit on top of the base of tongue muscle and create excess volume in a tight space. The lingual tonsils are removed using the Da Vinci robot; in some cases a portion of the tongue muscle will also be removed. Patients who undergo lingual tonsillectomy have failed CPAP or other measures and are interested in surgical treatment for their problem. This procedure may be combined with tonsillectomy, uvulopalatopharyngoplasty, palatal z-plasty or lateral pharyngoplasty.

Work at the base of the tongue on a patient with obstructive sleep apnea may compromise breathing in the first 24-48 hours. Patients who undergo this procedure are admitted to the ICU overnight. The breathing tube placed at the time of surgery is typically removed in the operating room. Most patients are discharged from the hospital on the day after surgery; if a longer stay is necessary, patients are transferred to a regular hospital room where the atmosphere is more restful.

Frequent complaints after surgery include numbness of the tongue, altered taste, coated tongue and a sense of tightness at the back of the throat. These symptoms generally resolve over 3 months.

 

Complications can include a chipped tooth, lip abrasion, tongue weakness, and bleeding. Although very rare, compromised breathing due to swelling after surgery could require tracheostomy. The most common time for post-operative bleeding is 7-10 days after surgery; this occurs in less than 5% of patients I ask that patients not travel for 2 weeks after surgery in order to minimize the risk and allow them to receive prompt attention should they have a problem with bleeding or pain control.