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Published on: December 6, 2016
Characterization of obstructive sleep apnea before and after tongue-lip adhesion in children with micrognathia
Ahmad R Sedaghat1, Iee Ching W Anderson, Brian M McGinley
1Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine, 601 North Caroline Street, Room 6231, Baltimore, MD 21287, USA.
Insights
Tongue-lip adhesion surgery can improve obstructive sleep apnea in infants with micrognathia. Polysomnography showed that this procedure often alleviates airway obstruction, though complete resolution is less common.
Area of Science:
- Pediatric Otolaryngology
- Sleep Medicine
- Craniofacial Surgery
Background:
- Micrognathia is a condition characterized by an abnormally small jaw, often leading to airway obstruction and obstructive sleep apnea (OSA).
- Tongue-lip adhesion is a surgical procedure sometimes used to manage airway issues in infants with micrognathia.
- Polysomnography is the gold standard for diagnosing and assessing the severity of sleep-disordered breathing.
Purpose of the Study:
- To evaluate the effectiveness of tongue-lip adhesion in improving airway obstruction in children with micrognathia.
- To characterize changes in polysomnographic parameters before and after tongue-lip adhesion surgery.
Main Methods:
- Retrospective pilot case series involving eight children with micrognathia who underwent polysomnography before and after tongue-lip adhesion.
- Analysis of polysomnography data including obstructive apnea-hypopnea index (OAHI), end-tidal pCO2, and oxygen saturation nadir.
Main Results:
- Seven of eight (88%) children had severe OSA preoperatively (mean OAHI: 52.6 events/hour).
- Tongue-lip adhesion improved OAHI in 87.5% of patients, with a mean decrease of 34.5 events/hour.
- Postoperative improvements were also noted in peak end-tidal pCO2 and oxygen saturation nadir.
Conclusions:
- Tongue-lip adhesion can be an effective intervention for alleviating airway obstruction in micrognathic infants.
- While the procedure generally improves OSA, complete resolution occurred in only 38% of cases in this pilot study.
- Polysomnographic evaluation is crucial for assessing the efficacy of tongue-lip adhesion in managing OSA in this population.
Objectives:
To characterize airway obstruction before and after tongue-lip adhesion in children with micrognathia using polysomnography.
Design:
Retrospective pilot case series.
Participants And Methods:
Evaluation of all children with micrognathia who underwent tongue-lip adhesion and polysomnography before and after surgery from 2002 to 2007 (N = 8).
Results:
Eight children met inclusion criteria; six were girls. The mean interval between polysomnography and tongue-lip adhesion was 6 days (range, 2 to 13 days) preoperatively and 17 days (range, 5 to 32 days) postoperatively. Severe obstructive sleep apnea was identified in seven of eight (88%) children, with a mean preoperative obstructive apnea hypopnea index of 52.6 events per hour (range, 7.1 to 85.7 events per hour). None had significant central sleep apneas (>5 per hour). Tongue-lip adhesion resulted in a mean decrease of 34.5 events per hour (range, -65.8 to 71.6 events per hour). After tongue-lip adhesion, seven of eight (87.5%) patients had an improved obstructive apnea hypopnea index, with resolution of obstructive sleep apnea in one child and improvement to mild (two) and moderate (two) obstructive sleep apnea in four others. Only one child had an obstructive apnea hypopnea index that increased after tongue-lip adhesion. Peak end-tidal pCO(2) measurements were elevated in all eight children before surgery at a mean of 60 mm Hg (range, 52 to 76 mm Hg) that improved to 51 mm Hg (range, 45 to 59 mm Hg), with normal peak levels in four children. Oxygen saturation nadir improved from 73% (range, 58% to 81%) to 82% (range, 65% to 94%).
Conclusions:
Tongue-lip adhesion may be performed in micrognathic infants to alleviate airway obstruction. Polysomnographic evaluation in this pilot study before and after surgery suggests that tongue-lip adhesion usually improves obstructive sleep apnea, but only 38% had complete resolution. Future studies of tongue-lip adhesion efficacy should include polysomnographic evaluation.
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