California Sleep Institute

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Temperature Controlled Radiofrequency

This is a unique surgical procedure developed by the surgical and medical teams from Center for Facial and Airway Reconstructive Surgery and the Center of Excellence in Sleep Disorder Medicine at Stanford University Medical Center. The procedure is usually performed under local anesthesia in an outpatient surgical suite. It effectively treats Obstructive Sleep Apnea Syndrome ( OSAS ), snoring and nasal obstruction in Sleep-Disordered Breathing by shrinking excess tissue in the upper airway.

Turbinate - Radiofrequency
Palate - Radiofrequency
Tongue - Radiofrequency
Frequently Asked Questions
Bibliography

Radiofrequency Frequently Asked Questions

How does Radiofrequency treat Obstructive Sleep Apnea Syndrome?

Radiofrequency treats sleep apnea by shrinking excess soft tissue in the upper airway including the base of tongue, soft palate and nasal tissues (turbinate) under local anesthesia. The radiofrequency procedure for Obstructive Sleep Apnea Syndrome generates low heat (approximately 85°C) to create finely controlled coagulative lesions at precise locations within the upper airway.

How long does the procedure take?

Typically, the procedure for Obstructive Sleep Apnea Syndrome takes 30 to 45 minutes, with only five to 10 minutes required for actual radiofrequency energy delivery.

Can this procedure be done on an outpatient basis?

Yes. The procedure is commonly performed on an outpatient basis and patients can usually return to their normal activities the following day. Typically, more than one treatment is necessary to achieve optimal results except for nasal treatments where one treatment is standard.

What does the patient experience during the radiofrequency treatment?

You will be under local anesthesia. Patients may suffer significant pain and usually require pain medication for several weeks. This is in extreme cases as most patients undergoing radiofrequency treatment experience minor swelling and discomfort after the procedure, and may require pain medication for two to three days.

How effective is radiofrequency in the treatment of Obstructive Sleep Apnea Syndrome?

Radiofrequency therapy may effectively treat Obstructive Sleep Apnea Syndrome safely by shrinking a portion of the base of tongue, in moderately and severely affected patients with OSAS. Research results demonstrated that patients experienced an average of 17% and as much as 35% reduction in tongue tissue volume, a range comparable to conventional surgical techniques. We also found there were no post treatment problems with speech or swallowing after completion of treatment.

Who is a candidate for the radiofrequency procedure for Obstructive Sleep Apnea Syndrome?

All potential patients must partake in an overnight sleep study in order to confirm the presence of Obstructive Sleep Apnea Syndrome. An evaluation will also be conducted to determine the site or sites of the obstruction. The results will be able to tell if you will benefit from radiofrequency treatments.

What postoperative follow-up do you need after any form of surgical, laser or radiofrequency treatment?

  • Frequent office follow-ups to be sure that diet, wound and oral hygiene as well as sufficient pain control is established.
  • The wounds need to be inspected until complete healing has occurred. Fiber-optic visualization of your airway and X-rays aid in evaluating the caliber of your airway postoperatively.
  • Fiber-optic visualization of your airway and X-rays aid in evaluating the healing process and the overall outcomes of the surgery postoperatively.
  • If you have moderate or severe sleep apnea you need to use nasal CPAP, nasal BiPAP or a tracheotomy until a repeat sleep study reveals your disease is cured.
  • Approximately four to six months postoperatively, a repeat sleep study is performed to evaluate the result. These studies will then be reviewed with the individual patient and recommendations made as to follow up or a next step.

Bibliography:

1. Sweet W, Wepsic J. Controlled thermocoagulation of trigeminal ganglion and rootlets for differential destruction of pain fibers. Part 1: Trigeminal neuralgia. J Neurosurg 1974;3:143-156.

2. Jackman WM, Wang XZ, Friday KJ, et al. Catheter ablation of accessory atrioventricular pathways (Wolff-Parkinson-White syndrome) by radiofrequency current. N Engl J Med 1991;324:1605-11.

3. Issa M, Oesterling J. Transurethral needle ablation (‘TUNA‘): an overview of radiofrequency thermal therapy for the treatment of benign prostatic hyperplasia. Current Opinion in Urology 1996;6:20-7.

4. Schulmun CC, Zlotta AR. Transurethral needle ablation of the prostate for treatment of benign prostate hyperplasia: early clinical experience. Urology 1995;45:28-33.

5. LeVeen H, Wapnick S, Piccone V, et al. Tumor eradication by radiofrequency therapy. Response in 21 patients. JAMA 1976;253:2198-2200.

6. McGahan J, Schneider P, Brock J, et al. Treatment of liver tumors by percutaneous radiofrequency electrocautery. Semin Interventional Radiology 1993;10(2):143-9.

7. Powell NB, Riley RW, Troell RJ, et al. Radiofrequency volumetric reduction of the tongue. A porcine pilot study for the treatment of obstructive sleep apnea syndrome. Chest 1997;111:1348-55.

8. Powell N, Riley R, Troell, et al. Radiofrequency volumetric tissue reduction of the palate in subjects with sleep-disordered breathing. Chest 1998;113:1163-74.

9. Li K, Powell N, Riley R, et al. Radiofrequency volumetric tissue reduction for treatment of turbinate hypertrophy-a pilot study. Otolaryngol Head Neck Surg, 1998, in press.

10. Powell N, Zonato A, Weaver E, Li K, Troell R, Riley R, Guilleminault C. Radiofrequency Treatment of turbinate Hypertrophy in Subjects Using Continuous Positive Airway Pressure: A Randomized, Double-Blind, Placebo-Controlled Clinical Pilot Trial. The Laryngoscope, 2001;111;1783-90.

11. Powell N, Riley R, Guilleminault C: Radiofrequency tongue base reduction in sleep-disordered breathing: A pilot study. Otolaryngol Head Neck Surg, 1999;120:656-64.

12. Guilleminault C, Chervin R, Palombini L, Powell N. Radiofrequency (pacing and thermic effects) in the treatment of sleep-disordered breathing. Sleep. 2000 Jun 15;23 Suppl 4:S182-6.

13. Riley RW, Powell NB, Li KK, Weaver EM, Guilleminault C. An adjunctive method of radiofrequency volumetric tissue reduction of the tongue for OSAS. Otolaryngology Head and Neck Surgery, 129(1): 37-42. 2003.