Radiofrequency treatment of the tongue is performed to treat snoring and obstructive sleep apnea. There are multiple names that have been used to describe tongue radiofrequency, including radiofrequency ablation (RFA), Somnoplasty, tongue Coblation, or VOAT. Most surgeons treat only the tongue base, but Dr. Kezirian goes beyond this to treat four areas of the tongue: the back, underneath the tongue, and each side. This is based on his working with the pioneers who have developed techniques to use radiofrequency in the US and around the world.

The tongue is primarily composed of muscle.  During sleep, the muscle can relax, contributing to blockage of breathing in the Tongue Region.  Tongue radiofrequency works by using a specially-designed probe heats the tongue tissues in a controlled fashion and create a certain amount of damage. The repair of that damage includes formation of a scar. This shrinks the tongue slightly, and it also makes it less likely that the tongue falls backward to block breathing during sleep.

Tongue radiofrequency has the advantage of a recovery that is much easier than with some other sleep apnea procedures. However, the key is a careful evaluation to determine whether a patient would be likely to benefit from tongue radiofrequency. Dr. Kezirian gives lectures around the world about the selection of various procedures to treat Tongue Region obstruction and can guide patients to make the best decision about whether tongue radiofrequency or another procedure is right for them.

How is tongue radiofrequency surgery performed?

This procedure can be performed in the operating room, or it can be performed in the outpatient clinic without requiring general anesthesia or sedation. Most patients undergoing tongue radiofrequency should expect a total of 2-3 treatment sessions.

Tongue radiofrequency can be performed with multiple technologies, and some of these have brand names such as Coblation or Somnoplasty. As a sleep apnea surgery expert, Dr. Kezirian is familiar with all of these technologies and the most recent studies about the their results in treatment of sleep apnea.

The probe in placed into the muscle at the back of the tongue to deliver treatment

The probe in then placed into the muscle underneath the tongue to deliver treatment

Healing causes shrinkage and tightening of the tongue tissues, and more space for breathing is created

 

The following video presents a discussion of Tongue Region procedures, including tongue radiofrequency:

The following video discusses snoring surgery, including tongue radiofrequency:

 

RISKS

Bleeding

As with any procedure, there is a risk of bleeding. Bleeding in this area can be serious and life-threatening. Fortunately, this is uncommon, and usually there is only minor bruising. A major factor in preventing serious bleeding is to avoid the use of aspirin, NSAIDs (such as ibuprofen, Advil®, Motrin®, naproxen, or Aleve®), vitamin supplements, or herbal medications for at least two weeks before and after surgery.

Infection

To reduce the risk of infection, patients rinse their mouth with an antiseptic prior to the procedure. Patients receive antibiotics at the time of the procedure to reduce the chance of infection. The risk of infection with these precautions is low, but tongue infections can also be serious and life-threatening.

Tongue numbness or tingling

There is a nerve (lingual nerve) that is responsible for the senses of touch and taste for the tongue. Radiofrequency treatment involves heating part of the tongue, and this can produce nerve damage. This nerve is located along the sides of the tongue deep down in the tongue, and therefore the treatments are primarily given to the central part of the tongue and the superficial areas on the sides of the tongue. If nerve damage or these symptoms do occur, usually the damage is temporary with recovery over the course of days or weeks, but the damage can take months to recover or be permanent.

Tongue weakness or trouble swallowing

A second nerve (hypoglossal nerve) on each side of the tongue is responsible for tongue movement. It also can be injured during radiofrequency treatment, but the same precautions reduce the risk of injury as for the lingual nerve (described directly above). The tongue is important for swallowing and either nerve injury or the swelling that occurs after a tongue procedure can present some difficulty with swallowing. If damage does occur, this should recover over the course of days or weeks, but the damage can take months to recover or be permanent.

Change in voice

Changes in voice may occur if there is injury to a nerve (hypoglossal nerve) on each side of the tongue is responsible for tongue movement. Changes in voice can also occur related to the effects of the tongue tightening and shrinkage that occurs with radiofrequency. If changes occur, they will typically resolve soon after surgery. However, permanent changes are possible. For additional information, please see Dr. Kezirian’s blog entry about changes in voice that can occur after tongue radiofrequency.

Need for additional procedures

Tongue radiofrequency treatment may not be effective in accomplishing the goals of surgery. Another procedure—either performed on the Tongue Region or on another area—may be necessary.

 

POSTOPERATIVE INSTRUCTIONS

NOTIFY DR. KEZIRIAN IMMEDIATELY IF YOU HAVE ANY TROUBLE BREATHING OR IF ANY BLEEDING DEVELOPS!

Pain control

Like most surgeries, there is pain in the recovery period. Most patients experience mild to moderate pain for 1-3 days. The pain should improve after the first 2 days. If there is a second spike up in pain, especially if there is any trouble in breathing or swallowing, contact Dr. Kezirian. You will receive a pain medication to take as you need it. Some people try to “hang in there” or suffer without taking pain medications. Controlling your pain is important for breathing, healing, and being able to swallow enough to maintain your nutrition.

Ice in the mouth

Holding ice in the mouth while they melt and cool the surgical area can help with pain control.  Doing this for the first 2-3 days after surgery is somewhat similar to applying ice to a sprained ankle.  It is one of the safest ways to reduce pain and can make the healing process easier.

Nutrition and fluids

It is very important to have good nutrition and avoid dehydration after surgery. Due to the pain and swelling that is expected after surgery, you will most likely only be able to tolerate a liquid diet for the first 1-3 days after surgery. Push yourself to drink fluids, even if it is painful. The first sign of dehydration is a decrease in urination, so keep track of this. In addition to water, it is It is helpful to drink other liquids, such as juices or Gatorade®. It is also essential that your body receive protein and fat in your diet to help with healing and maintaining your energy level. Every day, you should have 3 glasses of something with fat and protein like milk or chocolate milk, nutritional supplements like Muscle Milk® or Ensure®, or protein shakes. Dr. Kezirian may order a nutritional supplement like this while you are in the hospital. As your recovery continues, you will transition to soft solid foods such as eggs, yogurt, or mashed potatoes. You should be able to tolerate a fairly normal diet by 2 weeks after surgery. During the recovery period, you should avoid foods with sharp edges such as chips because these can cause bleeding. Otherwise, you can advance your diet according to your own schedule, being careful not to cause too much pain. Dr. Kezirian wants his patients to maintain their nutrition so that they do not lose weight in the few weeks right after surgery.

Antibiotics

Most patients receive an antibiotic after the procedure. This can be useful for preventing infection and decreasing swelling. Take the antibiotics as directed. If you develop a rash or diarrhea (possible risks of antibiotics and other medications), stop the antibiotics and contact Dr. Kezirian immediately.

Activity

Walking after surgery is important. Patients should walk at least 3 times a day starting the day after surgery. Walking helps prevent blood clots from forming in your legs. Spending more time out of bed (walking or in a chair) than in bed is helpful because your lungs fill up with air, lowering the risk of fevers and pneumonia. Not walking enough is a major cause of fevers after surgery, so please do remember to walk at least 3 times every day. Patients should avoid strenuous activity for 2 weeks following surgery because that typically raises heart rate and blood pressure. For this reason, it can increase swelling or cause bleeding to start.

Do not use mouthwashes, lozenges, or throat sprays

Patients should not use mouthwashes, lozenges, or throat sprays following surgery because many of these contain alcohol or other chemicals that can irritate the lining of the mouth or numbing medication that can expose you to a serious complication when used for more than a couple of times.

Ear problems or jaw discomfort

The swelling in your throat that occurs after surgery can cause jaw pain or ear symptoms such as pain, pressure, or fullness. This is common and should improve within 1-2 weeks following surgery. It occurs because the soft palate and tonsils are next to the jaw and the small Eustachian tube that connects the space behind the eardrum to the top of the throat. Swelling in the throat can interfere with your ability to clear or pop your ears, and it can also be sensed by your body as pain coming from your ears even though the ears are not affected (a phenomenon called referred pain).

Sleep with head elevated (at 45 degrees) for at least three days

Elevating your head during sleep decreases blood flow to the head and neck regions. Therefore, it decreases swelling and the associated pain. Elevating the head during sleep may also improve breathing patterns in other ways. Therefore, we recommend elevating your head during sleep at 45 degrees for at least three days following the procedure.

Nausea and constipation

Nausea and constipation are very common after any surgery. The anesthetic medications that you receive during surgery and the narcotic pain medication you receive after surgery can cause these. You will receive medications after surgery to decrease nausea and constipation, but please notify Dr. Kezirian if you feel constipated or have not had a bowel movement in any 3 days after surgery.

Postoperative appointment

Dr. Kezirian likes to see his patients 1-2 weeks after surgery. If a postoperative appointment has not been scheduled, please contact the office to schedule this when you return home after your surgery.

Additional questions

For any emergencies, please call 911 or go to the nearest emergency room.  For other questions, please call the UCLA Health System page operator at (424) 259-6700 and ask for the Head and Neck Surgery resident on call.