{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T00:39:17Z","timestamp":1771547957696,"version":"3.50.1"},"reference-count":39,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2022,8,24]],"date-time":"2022-08-24T00:00:00Z","timestamp":1661299200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objectives: To evaluate the safety and efficacy of a novel technique for transoral tongue suspension (TOTS) in obstructive sleep apnea (OSA) patients. Material and Methods: The retrospective study enrolled 24 consecutive OSA patients (21 males; average age, 43 years; average apnea\u2013hypopnea index (AHI), 42.2 event\/h; average body mass index (BMI), 25.7 kg\/m2) with tongue obstruction confirmed by drug-induced sleep endoscopy. All patients received TOTS as the main procedure in conjunction with uvulopalatopharyngoplasty (UPPP). Key procedures of TOTS included a transoral sublabial approach, drilling two holes on the mandible, passing the polypropylene through the hole to the tongue base using a suture passer and returning the polypropylene through loop traction, and tying the polypropylene to the mandible. Lingual tonsil ablation (n = 8) was also implemented in hypertrophic lingual tonsils (grades III and IV). Results: The operation time for TOTS was around 30 min. No wound bleeding or airway compromise occurred throughout the postoperative period. Minor complications were temporary and included swelling of the tongue, numbness of the lower incisor, and sublabial wound dehiscence (n = 2). The quality of life improved significantly in the patients\u2019 subjective daytime sleepiness according to the Epworth Sleepiness Scale (11.4 \u00b1 3.2 vs. 5.7 \u00b1 1.6, p &lt; 0.001). The objective parameters of OSA also improved significantly in the apnea\/hypopnea index (42.2 \u00b1 21.8 vs. 19.5 \u00b1 16.2, p &lt; 0.001), minimal oxygen saturation (77.1 \u00b1 12.2 vs. 81.7 \u00b1 8.1, p = 0.026), and snoring index (207 \u00b1 141 vs. 101 \u00b1 91, p = 0.03). Conclusions: The demonstrated TOTS showed its advantage in low morbidity with a scarless exterior and easy performance with free availability in treating adult OSA patients with tongue obstruction. TOTS combined with UPPP significantly improved AHI and daytime sleepiness. TOTS can be implemented with lingual tonsillectomy to achieve both stabilization of the tongue and widening of hypopharyngeal airway.<\/jats:p>","DOI":"10.3390\/jcm11174960","type":"journal-article","created":{"date-parts":[[2022,8,24]],"date-time":"2022-08-24T23:48:58Z","timestamp":1661384938000},"page":"4960","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Transoral Tongue Suspension for Obstructive Sleep Apnea\u2014A Preliminary Study"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9201-0270","authenticated-orcid":false,"given":"Li-Jen","family":"Hsin","sequence":"first","affiliation":[{"name":"Departments of Otolaryngology-Head & Neck Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan 33305, Taiwan"},{"name":"College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi-Chan","family":"Lee","sequence":"additional","affiliation":[{"name":"College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan"},{"name":"Departments of Otolaryngology-Head & Neck Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 20401, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5782-8835","authenticated-orcid":false,"given":"Wan-Ni","family":"Lin","sequence":"additional","affiliation":[{"name":"Departments of Otolaryngology-Head & Neck Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan 33305, Taiwan"},{"name":"College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi-An","family":"Lu","sequence":"additional","affiliation":[{"name":"Departments of Otolaryngology-Head & Neck Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan 33305, Taiwan"},{"name":"College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8414-595X","authenticated-orcid":false,"given":"Li-Ang","family":"Lee","sequence":"additional","affiliation":[{"name":"Departments of Otolaryngology-Head & Neck Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan 33305, Taiwan"},{"name":"College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9314-5940","authenticated-orcid":false,"given":"Ming-Shao","family":"Tsai","sequence":"additional","affiliation":[{"name":"College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan"},{"name":"Departments of Otolaryngology-Head & Neck Surgery, Chang Gung Memorial Hospital, Chayi Branch, Chayi 61363, Taiwan"},{"name":"Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan"},{"name":"Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wen-Nuan","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Sports Sciences, University of Taipei, Taipei 11153, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yen-Ting","family":"Chiang","sequence":"additional","affiliation":[{"name":"Departments of Otolaryngology-Head & Neck Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan 33305, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9016-8098","authenticated-orcid":false,"given":"Hsueh-Yu","family":"Li","sequence":"additional","affiliation":[{"name":"Departments of Otolaryngology-Head & Neck Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan 33305, Taiwan"},{"name":"College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,8,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1056\/NEJM199601113340207","article-title":"Obstructive sleep apnea","volume":"334","author":"Strollo","year":"1996","journal-title":"N. Engl. J. Med."},{"key":"ref_2","first-page":"920","article-title":"Epidemiological aspects of obstructive sleep apnea","volume":"7","author":"Garvey","year":"2015","journal-title":"J. Thorac. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1164\/rccm.201303-0448OC","article-title":"Defining phenotypic causes of obstructive sleep apnea. Identification of novel therapeutic targets","volume":"188","author":"Eckert","year":"2013","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_4","first-page":"672","article-title":"Progress in Detection of Insomnia Sleep Disorder: A Comprehensive Review","volume":"22","author":"Akhtar","year":"2021","journal-title":"Curr. Drug Targets"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1233","DOI":"10.1007\/s00405-011-1633-8","article-title":"Drug-induced sleep endoscopy: The VOTE classification","volume":"268","author":"Kezirian","year":"2011","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Lee, L.A., Yu, J.F., Lo, Y.L., Chen, N.H., Fang, T.J., Huang, C.G., Cheng, W.N., and Li, H.Y. (2014). Comparative effects of snoring sound between two minimally invasive surgeries in the treatment of snoring: A randomized controlled trial. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0097186"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1001\/archotol.132.2.206","article-title":"Hypopharyngeal surgery in obstructive sleep apnea: An evidence-based medicine review","volume":"132","author":"Kezirian","year":"2006","journal-title":"Arch. Otorhinolaryngol.\u2014Head Neck Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1601","DOI":"10.1378\/chest.11-2214","article-title":"Neurocognitive impairment in obstructive sleep apnea","volume":"141","author":"Lal","year":"2012","journal-title":"Chest"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2034","DOI":"10.1056\/NEJMoa043104","article-title":"Obstructive sleep apnea as a risk factor for stroke and death","volume":"353","author":"Yaggi","year":"2005","journal-title":"N. Engl. J. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/S0140-6736(08)61622-0","article-title":"Obstructive sleep apnoea and its cardiovascular consequences","volume":"373","author":"Bradley","year":"2009","journal-title":"Lancet"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1016\/S0140-6736(81)92140-1","article-title":"Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares","volume":"1","author":"Sullivan","year":"1981","journal-title":"Lancet"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/j.anl.2020.03.007","article-title":"How to manage continuous positive airway pressure (CPAP) failure-hybrid surgery and integrated treatment","volume":"47","author":"Li","year":"2000","journal-title":"Auris Nasus Larynx"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1177\/019459988108900609","article-title":"Surgical correction of anatomic abnormalities in obstructive sleep apnea syndrome: Uvulopalatopharyngoplasty","volume":"89","author":"Fujita","year":"1981","journal-title":"Otolaryngol.\u2014Head Neck Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1093\/sleep\/19.2.156","article-title":"The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome","volume":"19","author":"Sher","year":"1996","journal-title":"Sleep"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1537","DOI":"10.1093\/sleep\/29.12.1537","article-title":"Prediction of uvulopalatopharyngoplasty outcome: Anatomy-based staging system versus severity-based staging system","volume":"29","author":"Li","year":"2006","journal-title":"Sleep"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.jsmc.2018.10.007","article-title":"Volumetric Tongue Reduction for Obstructive Sleep Apnea","volume":"14","author":"Lin","year":"2019","journal-title":"Sleep Med. Clin."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2895","DOI":"10.1007\/s00405-015-3814-3","article-title":"A systematic review of tongue base suspension techniques as an isolated procedure or combined with uvulopalatopharyngoplasty in obstructive sleep apnea","volume":"273","author":"Bostanci","year":"2016","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1002\/lary.24187","article-title":"Tongue suspension: An evidence-based review and comparison to hypopharyngeal surgery for OSA","volume":"124","author":"Handler","year":"2014","journal-title":"Laryngoscope"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1067\/mhn.2002.123548","article-title":"Role of the tongue base suspension suture with The Repose System bone screw in the multilevel surgical management of obstructive sleep apnea","volume":"126","author":"Miller","year":"2002","journal-title":"Otolaryngol.\u2014Head Neck Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/j.otohns.2005.02.009","article-title":"Tongue base suspension combined with UPPP in severe OSA patients","volume":"133","author":"Omur","year":"2005","journal-title":"Otolaryngol.\u2014Head Neck Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"8788","DOI":"10.1038\/s41598-018-27094-w","article-title":"The effect of tongue base suspension with uvulopalato-pharyngoplasty on sleep quality in obstructive sleep apnea","volume":"8","author":"Tsou","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1378\/chest.103.1.30","article-title":"Daytime sleepiness, snoring, and obstructive sleep apnea. The Epworth Sleepiness Scale","volume":"103","author":"Johns","year":"1993","journal-title":"Chest"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1097\/00005537-200403000-00013","article-title":"Staging of obstructive sleep apnea\/hypopnea syndrome: A guide to appropriate treatment","volume":"114","author":"Friedman","year":"2004","journal-title":"Laryngoscope"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1111\/anae.14569","article-title":"A review of ASA physical status\u2014Historical perspectives and modern developments","volume":"74","author":"Mayhew","year":"2019","journal-title":"Anaesthesia"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1177\/0194599815568970","article-title":"A standardized lingual tonsil grading system: Inter-examiner agreement","volume":"152","author":"Friedman","year":"2015","journal-title":"Otolaryngol.\u2014Head Neck Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1007\/s00405-014-3475-7","article-title":"Coblation endoscopic lingual lightening (CELL) for obstructive sleep apnea","volume":"273","author":"Li","year":"2016","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.wjorl.2017.05.003","article-title":"Transoral robotic surgery for obstructive sleep apnea syndrome: Principles and technique","volume":"13","author":"Vicini","year":"2017","journal-title":"World J. Otorhinolaryngol. Head Neck Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1053\/joms.2001.27111","article-title":"Obstructive sleep apnea surgery: Genioglossus advancement revisited","volume":"59","author":"Li","year":"2001","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1016\/j.jcms.2007.04.008","article-title":"Genioglossus advancement and hyoid myotomy in treating obstructive sleep apnoea syndrome\u2013A follow-up study","volume":"35","author":"Pretl","year":"2007","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1067\/mhn.2001.113661","article-title":"A Tongue Suspension Suture for Obstructive Sleep Apnea and Snorers","volume":"124","author":"Woodson","year":"2001","journal-title":"Otolaryngol.\u2014Neck Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.otot.2015.08.002","article-title":"Tongue base suspension procedures for obstructive sleep apnea syndrome","volume":"26","author":"Kocdor","year":"2015","journal-title":"Oper. Tech. Otolaryngol.-Head Neck Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1016\/j.anl.2010.11.013","article-title":"Modified tongue base suspension for multilevel or single level obstructions in sleep apnea: Clinical and radiologic results","volume":"38","author":"Sezen","year":"2011","journal-title":"Auris Nasus Larynx."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"3411","DOI":"10.1007\/s00405-014-3311-0","article-title":"Predicting the outcome of modified tongue base suspension combined with uvulopalatopharyngoplasty","volume":"272","author":"Turhan","year":"2015","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1001\/jamasurg.2017.3366","article-title":"Safety and outcomes of the transoral endoscopic thyroidectomy vestibular approach","volume":"153","author":"Anuwong","year":"2018","journal-title":"JAMA Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1007\/s00405-014-3034-2","article-title":"The impact of modified tongue base suspension on CPAP levels in patients with severe OSA","volume":"272","author":"Turhan","year":"2015","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"3336","DOI":"10.1002\/hed.26383","article-title":"Cosmetic outcomes following transoral versus transcervical thyroidectomy","volume":"42","author":"Chen","year":"2020","journal-title":"Head Neck"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1097\/01.mlg.0000224498.09015.d9","article-title":"Tongue-base suspension in conjunction with uvulopalatopharyngoplasty for treatment of severe obstructive sleep apnea: Long-term follow-up results","volume":"116","author":"Vicente","year":"2006","journal-title":"Laryngoscope"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1067\/mhn.2000.102119","article-title":"Pharyngeal suspension suture with repose bone screw for obstructive sleep apnea","volume":"122","author":"Woodson","year":"2000","journal-title":"Otolaryngol.\u2014Head Neck Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.1007\/s00405-015-3813-4","article-title":"Long-term results of one staged multilevel surgery with tongue suspension surgery or one level palatal surgery for treatment of moderate and severe obstructive sleep apnea","volume":"273","author":"Ugur","year":"2016","journal-title":"Eur. Arch. Otorhinolaryngol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/17\/4960\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:14:31Z","timestamp":1760141671000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/17\/4960"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,24]]},"references-count":39,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2022,9]]}},"alternative-id":["jcm11174960"],"URL":"https:\/\/doi.org\/10.3390\/jcm11174960","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,24]]}}}