Techniques for evaluation and management of tongue-base obstruction in pediatric obstructive sleep apnea

Abstract

Purpose of review Tongue-base obstruction (TBO) is a common cause of persistent obstructive sleep apnea (OSA) after tonsillectomy and adenoidectomy in children. This review discusses available diagnostic modalities and surgical treatment options for the management of TBO. Recent findings Recently, a systematic review that included nine studies using drug-induced sleep endoscopy (DISE) in the evaluation of children with persistent OSA after tonsillectomy and adenoidectomy identified the tongue-base as the most common site of obstruction. Summary TBO is a common and correctable cause of persistent OSA in children. Diagnostic modalities include awake flexible laryngoscopy, plain neck films, DISE, and cine MRI. Because DISE and cine MRI are performed in a sleep-like state, they are fairly reliable in identifying the site of obstruction. As continuous positive airway pressure is often poorly tolerated in the pediatric population, there is considerable interest in surgical options for TBO. Depending on the location and the severity of the obstruction, interventions such as lingual tonsillectomy, posterior midline glossectomy, tongue suspension suture, epiglottopexy, hypoglossal nerve stimulation, tongue–lip adhesion, and hyoid suspension may play a role in management.

Can Tonsillar Retractor–Induced Tongue Edema Be a New Complication in Pediatric Patients Undergoing Tonsillectomy Detected by Ultrasonography? A Prospective, Case-Controlled, Observational Study

“…Walker et al 17 also noted that the increased risk in these children was due to upper airway edema, but they did not specify a definitive cause or localization. And also, Ishman et al 18 implicated that in children who had just undergone tonsillectomy surgeries, tongue-based obstruction is an important cause of respiratory complications that occur after tonsillectomy surgeries.…”

<p>Hypoglossal Nerve Stimulation in the Treatment of Obstructive Sleep Apnea: Patient Selection and New Perspectives</p>

“…49,50 OSA represents an important comorbidity for this population, and hopefully the device will be approved by the FDA for children in the near future. 51 At present, previous OSA surgery seems to not represent a predictor of HNS response. Although a stratified analysis in the German Postmarket study revealed that a previous uvulopalatopharyngoplasty (UPPP) is associated with higher risk of being non-responders, 43 but as more patients have been included this tendency has not been observed.…”

Pediatric Modifications to Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea: How I Do It

“…We also recognize that HGNS is not the only mechanism available to treat OSA attributable to tongue base collapse in the pediatric population. Such children also can be considered for lingual tonsillectomy, posterior midline glossectomy, tongue suspension suture, epiglottopexy, tongue‐lip adhesion, and hyoid suspension 8 …”

“…Such children also can be considered for lingual tonsillectomy, posterior midline glossectomy, tongue suspension suture, epiglottopexy, tongue-lip adhesion, and hyoid suspension. 8…”