The tongue plays a major role in sleep apnea for about 60 percent of patients. Midline glossectomy — using various techniques, including lingual tonsillectomy and submucosal lingualplasty — is performed in patients with large tongues who have obstructive sleep apnea. The tongue can be enlarged for a number of reasons, whether due to an increase in muscle, fat or tonsil tissue in the tongue. For example, studies have shown that weight gain can lead to the deposition of fat in the tongue itself, making the tongue physically larger. This enlargement compounds the tendency of the tongue, largely composed of muscle, to fall backwards during sleep and block breathing.
Midline glossectomy involves removing portions of the middle and back of the tongue. For extensive procedures, the major blood vessels and nerves are identified via ultrasound and protected during the procedure.