Radiofrequency ablation of the soft palate for snoring (somnoplasty)
Simple snoring is defined as a sleeping disease in which there is increased resistance to airflow in the upper airways
- characterised by turbulent airflow, vibration of the walls and a characteristic respiratory noise, which can become highly intense and be very annoying. Simple snoring is different from obstructive sleep apnoea-hypopnoea syndrome (OSAHS) because there are no respiratory arrests of at least 10s duration at a minimum rate of 5 per hour
- radiofrequency ablation aims to stiffen the soft palate and reduce vibration in the upper airways
- may be combined with other techniques (such as removal of the uvula or tonsillectomy) to reduce airflow obstruction and vibration in the airway
- procedure is usually done using local anaesthesia in outpatients
- an electrode delivery device is introduced into the mouth and directed upwards towards the soft palate
- a needle tip makes a series of very shallow punctures in the underlying muscle
- radiofrequency energy is delivered at each puncture site, commonly in the mid-portion of the palate from the uvular base to the posterior nasal spine
- alternatively, 2 lateral applications can be given at a lower energy setting and to several areas on either side
- radiofrequency is based on the production of high temperatures (of up to 80°C) in the submucosal tissue
- temperature rise causes a local and controlled destruction of tissue bonds, whose subsequent scarring decreases tissue thickness and increases its rigidity. This reduces vibration of the soft tissues of the upper airways (UA) and possible secondary respiratory obstruction
- intention is to scar and tighten the soft palate. If necessary the procedure can be repeated several weeks later: it is often carried out 2 or 3 times
"...evidence suggests that there are no major safety concerns associated with radiofrequency ablation of the soft palate for snoring. The evidence on the short-term efficacy of the procedure is adequate, although uncertainties remain about its efficacy in the longer term.." (1)
Efficacy (2):
- excellently tolerated in the turbinates, and moderately tolerated when applied in the tonsils and tongue base
- selecting the location of the treatment through clinical and dynamic examination, it is possible to obtain a clinical improvement of snoring in 86.5% of patients and a cure of symptoms in 37.8%, within 6 months. Mean snoring also improves by 37% and mean daytime sleepiness by 34%
Complications (2):
- various studies have demonstrated the low incidence and complications, highlighting ulcers at the point of insertion of the electrodes as the most frequent
- other complications reported, although very rare, were abscess of the tongue base or tonsils, uvular oedema, oedema of the mouth bottom, palatal neuropathies, dysphagia and, as the only serious complication, one reported case of haemorrhage from pseudoaneurysm of the lingual artery, attributed to a prior radiofrequency intervention
- several studies have confirmed that neither the velopalatal function nor word phonation or articulation suffer permanent alterations with this surgical intervention
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