CO₂ laser lingual tonsil reduction as a treatment for tongue discomfort during hypoglossal nerve stimulation: a case report

The purpose of this investigation is to demonstrate a multimodality approach to the surgical management of obstructive sleep apnea. Hypoglossal nerve stimulator (HGNS) implantation has been a life-changing procedure for many patients with obstructive sleep apnea. When activated it produces tongue protrusion via electrical stimulation of the hypoglossal nerve. This advances the lingual tonsil, making the pharynx diameter greater. Unfortunately, for some patients the electrical stimulation required is too high and awakens the patient. In such cases the patient’s fragmented sleep is not improved with the hypoglossal nerve stimulator. Here we present a case where hypoglossal nerve stimulator and CO₂ laser lingual tonsil reduction are used in conjunction to reduce the hypoglossal nerve stimulator setting required for airway patency, thereby allowing the patient to sleep through the night. For those patients who are unable to tolerate hypoglossal nerve stimulator settings, a combined approach with lingual tonsil reduction may be an alternative.