Submucosal minimally invasive lingual excision: an effective, novel surgery for pediatric tongue base reduction.

Full Abstract

OBJECTIVES:
The aim of this study was to develop an effective single intraoral, minimally invasive technique to reduce the enlarged tongue base in children with obstructive macroglossia.

METHODS:
We present the anatomic dissection of fresh cadavers and a representative case series of children who underwent submucosal minimally invasive lingual excision (SMILE) with a plasma-mediated radiofrequency device (coblation) under intraoral ultrasonic and endoscopic guidance. Multiple anatomic dissections determined the relative location of the hypoglossal nerve and lingual neurovascular bundle in relation to removable tongue base musculature. A pediatric case series demonstrates the straightforward SMILE technique.

RESULTS:
Laboratory anatomic dissection and clinical lingual ultrasonography revealed the surgical safety borders for SMILE. The surgical safety and efficacy of SMILE is demonstrated by preoperative and postoperative clinical examinations and polysomnograms in children with obstructive macroglossia (such as Beckwith-Wiedemann and Down syndromes and tongue vascular malformation). Coblation submucosally removes excessive tongue base tissue through a small anterior tongue incision. SMILE was performed without excessive pain, bleeding, edema, infection, or tongue dysfunction.

CONCLUSIONS:
SMILE is an effective novel operation that incorporates coblation with ultrasonography and endoscopic guidance for children who need tongue base reduction. Anatomic dissection and clinical cases demonstrate the potential for aggressive yet relatively safe tissue removal by this minimally invasive technique. SMILE also has significant potential for adults with obstructive sleep apnea due to a large tongue base.

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Author information

Author/s: Maturo, Stephen C (SC); Mair, Eric A (EA);

Affiliation: Pediatric Otolaryngology Service, Department of Otolaryngology, Wilford Hall United States Air Force Medical Center, San Antonio, Texas, USA.

Journal and publication information

Publication Type: Case Reports; Journal Article

Journal: The Annals of otology, rhinology, and laryngology (Ann Otol Rhinol Laryngol), published in United States. (Language: eng)

Reference: 2006-Aug; vol 115 (issue 8) : pp 624-30

Dates: Created 2006/09/01; Completed 2006/10/03;

PMID: 16944662, status: MEDLINE (last retrieval date: 12/26/2008)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Adolescent
Adult
Airway Obstruction - etiology; surgery
Cadaver
Child
Female
Glossectomy - methods
Humans

Infant
Lingual Nerve
Macroglossia - complications; surgery
Sleep Apnea, Obstructive - etiology; surgery
Surgical Procedures, Minimally Invasive - methods
Tongue - surgery
Treatment Outcome
Ultrasonography, Doppler, Color

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