Authors (including presenting author) :
SUM YS (1), TO WHZ (1), CHAN MY (1), TSUI KC (1), HUI SC (1), NG CM (1), Li FC (1) ,Abdullah V (1)(2)
Affiliation :
(1) Department of Ear, Nose and Throat, United Christian Hospital, Kowloon East Cluster
(2) Department of Otorhinolaryngology, The Chinese University of Hong Kong
Introduction :
Obstructive Sleep Apnea (OSA) is one of the most common sleep disorder. Patients with untreated OSA will suffer higher risk of high blood pressure, diabetes, cardiovascular diseases and other conditions which will cause an increase in health care cost and health care utilization rate. Traditionally, CPAP in the gold standard of treatment of OSA, however, poor compliance in CPAP usage always a major concern. Lifelong usage and inconvenience further limit the usage of CPAP in patients with younger age. Orofacial myofunctional therapy (OMT) is an alternative therapy for OSA. OMT is a functional training of oral and facial muscle as a treatment for mild and moderate obstructive sleep apnea. It provide an alternative treatment option other than CPAP which may beneficial to patient which is not compliance with it. These functional training can also help to maintain the effects after sleep surgery in tongue, jaw and oropharyngeal region. In recent meta-analysis, OMT can reduce apnea-hypopnea index (AHI) by 10 in average, which means it can cure patient with mild degree of OSA and reduce the long-term health risks to cause other diseases due to OSA in patients with moderate degree of OSA.
Tongue tie is a condition that small amount of tissue remains at the button of the tongue after infant’s development. These tissues will cause restriction to the tongue and limit its mobility and may cause OSA. Tongue-tie release, or frenectomy, is a surgical operation to remove the restricted tissue under the tongue and resume its mobility. Orofacial myofunctional therapy helps the function restoration of the tongue after tongue-tie release.
Objectives :
This study is aim to illustrate the effect of OMT on patient undergone tongue-tie release in terms of OSA and tongue functionality. OMT training compliance in Hong Kong local setting is also investigated.
Methodology :
In our study, patients with tongue-tie and OSA were recruited to have frenectomy with 6-weeks OMT training. OMT training and tongue assessment was first performed face-to-face and followed by teleconsultation through KEC Telehealth ePlatform 3-weeks prior the operation and 3-weeks after the operation. Tongue-tie release was performed under local anaesthesia for all patients. Tongue mobility was monitored at the operation to ensure operation target achieved. Sleep parameters such as Respiratory-disturbance index (RDI) and oxygen desaturation index (ODI) were measured by polysomnography (PSG) before and after the program. Tongue strength, tongue mobility parameters (MIO, MOTTIP, and TRMR) were measured before the training program, before OT and after the program. OMT training compliance were self-reported by patient using google form.
Result & Outcome :
9 patients were recruited to the program. They had a mean age 30.1±20.9, body mass index (BMI) 24.2±4.7 and respiratory disturbance index of 18.8±15.3.
All patients attend are OMT training sessions, the overall training compliance is 74.0%±19.9%. The tongue mobility evaluated by tongue range of motion ratio (TRMR) showed significant improvement from 0.661 to 0.773 (p<0.05) and the mean tongue strength change from 40.8±10.9 to 52.6±10.5 compared before and after the program. The mean RDI of the patients changes from 18.8±15.3 to 10.9±7.9.
These results shows tongue tie release and OMT are a safe and effective method to improve tongue strength and mobility for selected patients. They are potentially useful adjunct treatment for obstructive sleep apnea.
