Lingual Tonsil HypertrophyGrading System

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Introduction

Surgical treatment of obstructive sleep apnea/hypopnea syndrome (OSAHS) has continued to evolve, with new techniques and modifications showing improvements in success. A simple preoperative patient selection method by which to determine the site of obstruction is both a necessity and priority in choosing patients who are likely to respond to surgical treatment. Therefore it is important to have a strategy to evaluate a patient's airway that is both efficient and noninvasive. Implementation of these strategies in the selection process not only results in better outcomes, but also clarifies understanding of the need for surgery in specific populations of sleep apnea patients.

With the availability of transoral robotic surgery (TORS), lingual tonsillectomy has become an important adjunctive procedure in the treatment of OSAHS. It is commonly combined with TORS glossectomy, but often performed as a standalone procedure. Nevertheless, indications and efficacy of TORS lingual tonsillectomy have not been studied in detail. Because consideration of the size of faucial tonsils or adenoids is a widely accepted indicator for removal of lymphoid tissue, indications and efficacy of lingual tonsillectomy must also be based on lingual tonsil size.

Although any staging system represents only an approximation, it is important that we have a common language in describing lingual tonsil size. This type of outpatient screening is critical to perform before consenting a patient for an invasive airway procedure. As such, when evaluating obstruction at the tongue base, a universal scale to grade LTH may be beneficial for surgical treatment and protocol.