Radiofrequency Volumetric Tissue Reduction of the Palate in Subjects With Sleep-Disordered Breathing: Cephalometric Radiographs Results

18 May
2014

Measurements were taken from the pretreatment radiographs and compared with those of posttreatment (Table 1). All radiographs were taken in the same anatomic head position that was assured by the use of a standardized, ridged, cephalometric head holder. The width of the soft palate (PW) did not change significantly (p=0.576). However, there was a significant reduction in the distance from the nasal spine to the soft palate (PNS-P) from 46.5±3.8 mm to 41.0±3.6 mm (p<0.()001). This finding depicts shrinkage of the free edge of the soft palate in the midline after treatment with RFe to that region. The following measurements were only documented at baseline, as it was expected there would be no changes in the skeletal (SNA, SNB) or soft tissues measurements at the tongue base (MP-H, PAS) since these areas were not treated or affected by treatment.
Infrared Thermal Imaging Results
Seven consecutive subjects underwent a single thermal imaging session during their RF treatments. Thermal imaging was used to assess the surface temperatures and clinically map the lateral extent of the lesion. A mean total energy delivery of 562 J (range, 562 to 700) over a mean treatment duration of 93.7 s (range, 79.0 to 113) was given to this group (Table 3). This trial was not extended to the remaining subjects since the data collection at n=7 was sufficient to confirm that the initial ranges of RF parameters were in a safe maximum upper limit. A typical thermogram is seen in Figure 2 and demonstrates the surface temperatures along with the characteristic spherical shape of an RF lesion. canadian neightbor pharmacy

Questionnaire Results
Epworth Sleepiness Scale: The pretreatment ESS (0 to 24) was a mean of 8.5±4.5, and posttreatment was a mean of 5.2±3.3, which is a change of —3.3±3.2 (p<0.00001).
VAS Results
Pain, Speech, and Swallowing: For each of the first four treatment sessions, Table 4 provides information about the mean number of joules that were administered, the duration of the treatment, and the subsequent effects on pain, speech, and swallowing measured on the first day following the four treatment sessions. We do not present data for treatments 5 and 6 because only three patients received five treatments, and only one received a sixth treatment.

Figure 2. Infrared thermogram immediately after RF treatment. Digital infrared thermogram taken immediately after withdrawal of the RF electrode. The maximum temperature at the midpalatal surface mucosa was 40.0°G. This surface temperature was found to be nondamaging to the surface mucosal integrity. The image depicts the character and lateral extent ol the lesion after delivery of 508 J of energy.

Figure 2. Infrared thermogram immediately after RF treatment. Digital infrared thermogram taken immediately after withdrawal of the RF electrode. The maximum temperature at the midpalatal surface mucosa was 40.0°G. This surface temperature was found to be nondamaging to the surface mucosal integrity. The image depicts the character and lateral extent ol the lesion after delivery of 508 J of energy.

Table 3—Infrared Thermal Imaging

Subject No.Base Temp Pre-Tx Temp-1Immediate Temp-23 sTemp-3 8 sFinal Temp 7 min JoulesWattsXSeconds TotalSeconds
135.141.542.141.436.5700113
233.447.3f46.645.134.760789
333.040.540.940.335.556279
433.440.339.739.434.452899
532.640.040.139.533.450879
634.141.741.941.834.755392
733.543.442.241.237.7479105
Mean33.642.141.241.235.356293.7
Minimum32.640.039.739.433.447979.0
Maximum35.147.346.645.137.7700113.0
SD0.812.561.081.941.4473.212.8

Table 4—Treatment Effects

Treatment No.No. of JoulesTreatment Duration, sPain Score (0-10)% Using Pain Medication DifficultySwallowing

(0-10)

Difficulty with Speech (0-10)
1 (n=22)739 ±185178±451.48±1.810/21=47,5%f0.69±1.11.17±1.6
2 (n=21)690 ±237136±471.62±1.88/21=38.1%1.35±1.71.06 ±1.2
3 (n=19)712±135130±431.05±1.24/19=21.0%1.22±1.31.00±2.2
©II548 ±4896 ±151.65 ±1.83/9=33.3%1.30±2.50.60±1.1
Posttreatment (n=22) 0.00±0.0 0.00±0.0 0.00±0.0
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