Biophysics of Our Procedure
The biophysics of radiofrequency ablation of the tongue (RFA) result in a predictable tissue injury pattern on the base of the tongue. Radiofrequency of the tongue generates frictional heating of the tissue around the electrode caused by ionic agitation. Thus, the electrode is not heated instead emanating from the tissue is the heat. With this method of energy disbursement, heat dissipation is limited and excessive tissue injury is minimized. Furthermore, when the temperature reaches 90-100 degrees C, char formation on the needle electrode leads to an increase in the impedance and results in disruption of current flow, thus serving as a second layer of protection from excessive tissue energy.
Post Procedure Reduction
Twenty-one days after the first procedure, continual reduction of tissue volume is evident. Due to the extent of edema being closely correlated with the amount of energy delivered, RFA is suited as an in-office procedure with sequential application of the radiofrequency energy with a healing period of 4-6 weeks between treatment sessions. By allowing the natural healing process to take its course, we effectively minimize the excessive postoperative edema and complications.
- 24 Hours – Twenty-four hours after performing RFA, there is evidence of cellular injury with mild interstitial edema and focal hemorrhage, with a margin of hyperemic tissue in the periphery. Most patients report mild throat agitation commonly referred to as a “scratchy throat.”
- One Week – One week after the treatment, there is prominent fibroblastic response, with collagen deposition replacing the injured tissue.
- Three Weeks – Three weeks after the treatment, a well-formed scar is observed at the site of the treated area. Assessments of the tongue volume revealed an initial edematous response that promptly tapered at 24 hours with subsequent tissue reduction 10 days after the first treatment.
History Surrounding the Procedure
Most OSA procedures have success rates below 50%, require General Anesthesia, and are significantly painful with prolonged recovery times. Most OSA patients are not good anesthetic risks, falling in the ASAII/III range. An Otolaryngologist usually only gets one surgical attempt at an OSA patient because the patient is not going to let you do anything else if the procedure is not successful.
RFA was first covered by Medicare under the generic 42999 code, and then retracted. With no reimbursement and patients reluctant to pay out cash, Somnoplasty of the Soft Palate and Tongue Base fell out of favor and my Somnoplasty Unit hit the shelf. Research did continue though, in the US and Abroad, in several academic centers. These results laid the groundwork for the eventual success of the AAO-HNS Sleep Apnea Committee, and in 2006, Medicare assignment CPT code 41530 for RFA of the Soft Palate/Tongue Base. The more important change came in 2009 when Medicare began reimbursing for RFA. Forty of fifty states currently reimburse for RFA. The only two Medicare Carriers who still do not are Wisconsin Physicians Services (WPS), covering the Great Lakes Area and First Coast (FC) in Florida.
Ten years ago, the procedure was initially performed in the OR under general anesthesia, and the patient was treated with a high dosage of energy in a single setting. Over the past 5 years we have been able to improve the curative outcomes and improve patient satisfaction by moving the procedure into the office setting.
Our physicians perform more RFA procedures per month than most physicians will perform in their lifetime. SATCOA physician partners are taught our minimally invasive Medicare-approved in-office procedure proven to cure sleep apnea. We provide professional training for up to two (2) medical professionals, other employees or independent contractors working for or in connection with your business at no additional charge. Training will be done at both our corporate location in Tampa, FL and at each partners’ respective practice location. Continuing education for our treatment protocols will be offered through The University of South Florida’s CAMLS Center – Center for Advanced Medical Learning and Simulation.
Read what one of our patients had to say about Sleep Apnea Treatment Centers of America
Before undergoing the RFA procedure I was constantly snoring, wasn’t sleeping well, and was forced to use a CPAP machine, which was extremely uncomfortable. After having the procedure done, I no longer take any medication to fall asleep! In regards to the office, I love the setup…It makes you feel comfortable. – Sheila F. Click Here to Read More Patient Testimonials