Base of Tongue Surgery and Pediatric Obstructive Sleep Apnea

Abstract

Objective Drug-induced sleep endoscopy–directed lingual tonsillectomy and midline posterior glossectomy have been employed for the treatment of obstructive sleep apnea in children. The purpose of this study is to evaluate outcomes in children undergoing lingual tonsillectomy, midline posterior glossectomy, or combined base of tongue reduction procedures for obstructive sleep apnea. Study Design Case series with chart review. Setting Tertiary care academic medical center. Methods A case series was performed with chart review of pediatric patients with obstructive sleep apnea who underwent base of tongue surgery as directed by drug-induced sleep endoscopy. Pre- and postoperative obstructive apnea-hypopnea index (oAHI) was compared. Age, sex, body mass index z score, and medical history were also evaluated. Results A total of 168 children were included, with a mean ± SD age of 8.3 ± 3.6 years. Of these patients, 101 underwent lingual tonsillectomy alone; 25, midline posterior glossectomy alone; and 42, both. Their mean oAHI improvement was 3.52 ± 8.39, 2.55 ± 5.59, and 3.70 ± 6.07, respectively. Each surgical group experienced significant improvement in sleep apnea when pre- and postoperative oAHI was compared ( P < .01). Overall surgical success, as defined by oAHI <1 (or <5 without clinical symptoms), was 75% (126 patients). Conclusion When guided by drug-induced sleep endoscopy, pediatric tongue base surgery can significantly improve oAHI and thus demonstrates promising success in treating pediatric obstructive sleep apnea.

Fluoroscopic‐Assisted Tongue Suspension: Advancement and Innovation in the Management of Complex Pediatric Obstructive Sleep Apnea

“…Lingual tonsillectomy with or without epiglottopexy has shown good results in managing OSA, with surgical success in 51-85% of patients. [13][14][15][16]35 Posterior midline glossectomy appears to be mostly effective in managing glossoptosis and macroglossia in non-obese children with Trisomy 21. 18 Genioglossal advancement and radiofrequency ablation have also shown promise, demonstrating nearly a 45% mean reduction in AHI.…”

“…There is currently no consensus on the standard surgical approach to management of base of tongue obstruction. Lingual tonsillectomy with or without epiglottopexy has shown good results in managing OSA, with surgical success in 51–85% of patients 13–16,35 . Posterior midline glossectomy appears to be mostly effective in managing glossoptosis and macroglossia in non‐obese children with Trisomy 21 18 .…”

“…Several studies have validated lingual tonsillectomy as an effective procedure for lingual tonsil hypertrophy. [13][14][15][16] Management of macroglossia and glossoptosis via midline posterior glossectomy and radiofrequency ablation has shown fair results but has been limited to small case series. 17,18 The role of hypoglossal nerve stimulation for the management of glossoptosis in the pediatric population is in its early stages and not yet applicable to those outside of Trisomy 21 with severe residual OSA.…”

“…Base of tongue obstruction can result from hypertrophy of the lingual tonsillar tissue, macroglossia, and/or glossoptosis. Several studies have validated lingual tonsillectomy as an effective procedure for lingual tonsil hypertrophy 13–16 . Management of macroglossia and glossoptosis via midline posterior glossectomy and radiofrequency ablation has shown fair results but has been limited to small case series 17,18 .…”

Clinical Application of Pediatric Sleep Endoscopy: An International Survey

“…Despite this evidence, pediatric DISE is a less widespread procedure in sleep centers and is discussed more in the scientific literature compared to DISE in adult OSA patients [5][6][7][8][9][10][11][12][13][14][15].…”