Lingual Tonsillectomy as Part of a DISE-Directed Multilevel Upper Airway Surgery to Treat Complex Pediatric OSA: A Safe and Appropriate Procedure.
continuous positive airway pressure
pediatric OSA
tongue base coblation
Journal
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
ISSN: 1097-6817
Titre abrégé: Otolaryngol Head Neck Surg
Pays: England
ID NLM: 8508176
Informations de publication
Date de publication:
15 Aug 2024
15 Aug 2024
Historique:
revised:
15
07
2024
received:
13
01
2024
accepted:
03
08
2024
medline:
16
8
2024
pubmed:
16
8
2024
entrez:
16
8
2024
Statut:
aheadofprint
Résumé
To study the efficiency of lingual tonsillectomy (LT) as part of multilevel surgery in children with complex obstructive sleep apnea (OSA). To evaluate the safety and the outcomes of LT. Retrospective case series. Pediatric tertiary care academic center. We included all children operated for LT to treat complex OSA, from January 2018 to June 2022. All patients underwent a protocolized drug-induced sleep endoscopy (DISE) followed by a coblation LT, associated with the treatment of all other obstructive sites. Patient demographics, medical history, surgery, and outcomes were reviewed. The efficiency of LT was analyzed exclusively in patients with a preoperative and postoperative sleep study. One hundred twenty-three patients were included. Median age was 8 years (interquartile range, IQR [3-12]). Sixty-five (53%) patients had Down syndrome, 22 (18%) had a craniofacial malformation, and 8 (7%) were obese. LT was associated with adenoidectomy (n = 78, 63%), partial tonsillectomy (n = 70, 57%), inferior turbinoplasty/turbinectomy (n = 59, 48%), epiglottoplasty (n = 92, 75%), and/or expansion pharyngoplasty (n = 2, 2%). Eighty-nine patients underwent a sleep study before and after surgery. The median apnea-hypopnea index (AHI) decreased from 18 events/h (IQR [9-36]) before surgery to 3 events/h (IQR [1-5]) after surgery (P < .001) (patients with a postoperative AHI <1.5 events/h, n = 31, 35%, and an AHI <5 events/h, n = 32, 36%). Seventeen out of 30 (57%) patients could be weaned from continuous positive airway pressure after surgery. Two patients had a postoperative hemorrhage and 2 patients required a transient postoperative reintubation. In children with complex OSA, LT as part of a DISE-directed multilevel upper airway surgery, was a very efficient and safe procedure.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 The Author(s). Otolaryngology–Head and Neck Surgery published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngology–Head and Neck Surgery Foundation.
Références
Gozal D, Tan HL, Kheirandish‐Gozal L. Obstructive sleep apnea in children: a critical update. Nat Sci Sleep. 2013;5:109‐123. doi:10.2147/NSS.S51907
Marcus CL, Brooks LJ, Draper KA, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2012;130(3):576‐584. doi:10.1542/peds.2012-1671
Mitchell RB, Archer SM, Ishman SL, et al. Clinical Practice Guideline: tonsillectomy in children (update)—executive summary. Otolaryngol Head Neck Surg. 2019;160(2):187‐205. doi:10.1177/0194599818807917
Bhattacharjee R, Kheirandish‐Gozal L, Spruyt K, et al. Adenotonsillectomy outcomes in treatment of obstructive sleep apnea in children: a multicenter retrospective study. Am J Respir Crit Care Med. 2010;182(5):676‐683. doi:10.1164/rccm.200912-1930OC
Ishman SL, Maturo S, Schwartz S, et al. Expert Consensus Statement: management of pediatric persistent obstructive sleep apnea after adenotonsillectomy. Otolaryngol Head Neck Surg. 2023;168(2):115‐130. doi:10.1002/ohn.159
Friedman M, Wilson M, Lin HC, Chang HW. Updated systematic review of tonsillectomy and adenoidectomy for treatment of pediatric obstructive sleep apnea/hypopnea syndrome. Otolaryngol Head Neck Surg. 2009;140(6):800‐808. doi:10.1016/j.otohns.2009.01.043
Watach AJ, Xanthopoulos MS, Afolabi‐Brown O, et al. Positive airway pressure adherence in pediatric obstructive sleep apnea: a systematic scoping review. Sleep Med Rev. 2020;51:101273. doi:10.1016/j.smrv.2020.101273
Baldassari CM, Lam DJ, Ishman SL, et al. Expert consensus statement: pediatric drug‐induced sleep. Otolaryngol Head Neck Surg. 2021;165(4):578‐591. doi:10.1177/0194599820985000
Williamson A, Coutras SW, Carr MM. Sleep endoscopy findings in children with obstructive sleep apnea and small tonsils. Ann Otol Rhinol Laryngol. 2022;131(8):851‐858. doi:10.1177/00034894211045645
Coutras SW, Limjuco A, Davis KE, Carr MM. Sleep endoscopy findings in children with persistent obstructive sleep apnea after adenotonsillectomy. Int J Pediatr Otorhinolaryngol. 2018;107:190‐193. doi:10.1016/j.ijporl.2018.01.029
Lookabaugh S, McKenna M, Karelsky S, et al. Drug‐induced sleep endoscopy findings in surgically‐naïve obese vs non‐obese children. Int J Pediatr Otorhinolaryngol. 2020;138:110289. doi:10.1016/j.ijporl.2020.110289
Kang KT, Koltai PJ, Lee CH, Lin MT, Hsu WC. Lingual tonsillectomy for treatment of pediatric obstructive sleep apnea. JAMA Otolaryngol Head Neck Surg. 2017;143(6):561‐568. doi:10.1001/jamaoto.2016.4274
Rivero A, Durr M. Lingual tonsillectomy for pediatric persistent obstructive sleep apnea: a systematic review and meta‐analysis. Otolaryngol Head Neck Surg. 2017;157(6):940‐947. doi:10.1177/0194599817725708
DeMarcantonio MA, Senser E, Meinzen‐Derr J, Roetting N, Shott S, Ishman SL. The safety and efficacy of pediatric lingual tonsillectomy. Int J Pediatr Otorhinolaryngol. 2016;91:6‐10. doi:10.1016/j.ijporl.2016.09.037
Williamson A, McArdle EH, Morrow VR, Zalzal HG, Carr MM, Coutras SW. Base of tongue surgery and pediatric obstructive sleep apnea. Otolaryngol Head Neck Surg. 2023;168(4):839‐847. doi:10.1177/01945998221094211
Williamson A, Morrow VR, Carr MM, Coutras SW. Safety and efficacy of lingual tonsillectomy in multilevel airway surgery for pediatric obstructive sleep apnea. J Clin Sleep Med. 2024;20(2):189‐199. doi:10.5664/jcsm.10816
Garcelon N, Neuraz A, Salomon R, et al. A clinician friendly data warehouse oriented toward narrative reports: Dr. Warehouse. J Biomed Inform. 2018;80:52‐63. doi:10.1016/j.jbi.2018.02.019
Berry RB, Budhiraja R, Gottlieb DJ, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. J Clin Sleep Med. 2012;08(5):597‐619. doi:10.5664/jcsm.2172
Parikh SR, Boudewyns A, Friedman NR, et al. International Pediatric Otolaryngology Group (IPOG) consensus on scoring of pediatric drug induced sleep endoscopy (DISE). Int J Pediatr Otorhinolaryngol. 2023;171:111627. doi:10.1016/j.ijporl.2023.111627
Leclere JC, Marianowski R, Monteyrol PJ, et al. Guidelines of the French Society of Otorhinolaryngology. Role of the ENT specialist in the diagnosis of obstructive sleep apnea‐hypopnea syndrome (OSAHS) in children. Part 2: diagnostic investigations apart from sleep studies. Eur Ann Otorhinolaryngol Head Neck Dis. 2019;136(4):295‐299. doi:10.1016/j.anorl.2019.05.016
Ulualp SO. Modified expansion sphincter pharyngoplasty for treatment of children with obstructive sleep apnea. JAMA Otolaryngol Head Neck Surg. 2014;140(9):817‐822. doi:10.1001/jamaoto.2014.1329
Prosser JD, Shott SR, Rodriguez O, Simakajornboon N, Meinzen‐Derr J, Ishman SL. Polysomnographic outcomes following lingual tonsillectomy for persistent obstructive sleep apnea in Down syndrome. Laryngoscope. 2017;127(2):520‐524. doi:10.1002/lary.26202
Simpson R, Oyekan AA, Ehsan Z, Ingram DG. Obstructive sleep apnea in patients with Down syndrome: current perspectives. Nat Sci Sleep. 2018;10:287‐293. doi:10.2147/NSS.S154723
Hyzer JM, Milczuk HA, Macarthur CJ, King EF, Quintanilla‐Dieck L, Lam DJ. Drug‐induced sleep endoscopy findings in children with obstructive sleep apnea with vs without obesity or Down syndrome. JAMA Otolaryngol Head Neck Surg. 2021;147(2):175‐181. doi:10.1001/jamaoto.2020.4548
Theilhaber M, Arachchi S, Armstrong DS, Davey MJ, Nixon GM. Routine post‐operative intensive care is not necessary for children with obstructive sleep apnea at high risk after adenotonsillectomy. Int J Pediatr Otorhinolaryngol. 2014;78(5):744‐747. doi:10.1016/j.ijporl.2014.01.032