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Transoral robotic surgery for sleep apnea in children: Is it effective?
Prasad John Thottam1, Nandini Govil2, Umamaheswar Duvvuri3
1Children's Hospital of Pittsburgh of UPMC, Pediatric Otolaryngology, 4401 Penn Ave, Pittsburgh, PA 15224, USA; Michigan Pediatric Ear, Nose and Throat Associates, 29120 Franklin Rd, Southfield, MI 48034, USA; Children's Hospital of Michigan, Detroit Medical Center, 3901 Beaubien St, Detroit, MI 48201, USA.
Insights
Transoral robotic surgery (TORS) effectively treats pediatric obstructive sleep apnea/hypopnea syndrome (OSAHS) caused by base of tongue (BOT) or lingual tonsil hypertrophy. This study found TORS significantly reduced obstructive events in children, offering a viable treatment option.
Area of Science:
- Otolaryngology
- Pediatric Sleep Medicine
- Robotic Surgery
Background:
- Pediatric obstructive sleep apnea/hypopnea syndrome (OSAHS) resulting from base of tongue (BOT) or lingual tonsillar hypertrophy often does not resolve with adenotonsillectomy.
- Transoral robotic surgery (TORS) is effective for adult OSAHS but its efficacy in children with BOT or lingual tonsil hypertrophy is not established.
Purpose of the Study:
- To evaluate the effectiveness of TORS for BOT reduction and lingual tonsillectomy in treating pediatric OSAHS.
- To assess the impact of TORS on polysomnographic parameters in children with specific airway obstructions.
Main Methods:
- Retrospective analysis of nine pediatric patients (5 non-syndromic, 4 syndromic) who underwent isolated BOT reduction and lingual tonsillectomy for OSAHS.
- Comparison of pre-operative and post-operative polysomnograms (PSGs) to determine procedural effectiveness.
- Analysis of patient demographics including age, sex, BMI, developmental status, and comorbidities.
Main Results:
- Mean obstructive apnea-hypopnea index (O-AHI) decreased significantly from 27.1 to 10.9 post-operatively (p≤0.05).
- Statistically significant reductions were observed in hypopneic events (p<0.05) and lowest oxygen saturation (p≤0.01).
- All patients achieved at least a 50% reduction in O-AHI; one patient experienced a controlled post-operative bleed.
Conclusions:
- TORS is a valuable and effective surgical option for children with airway obstruction due to BOT and lingual tonsillar hypertrophy.
- TORS leads to a significant decrease in obstructive events, improving respiratory parameters in pediatric OSAHS patients.
Objectives:
Children with obstructive sleep apnea/hypopnea syndrome (OSAHS) as a result of base of tongue (BOT) or lingual tonsillar hypertrophy do not improve following adenotonsillectomy. In adults, transoral robotic surgery (TORS) offers a means of treating such patients, however the efficacy of this technique for children is not known. In this study, we examine the effectiveness of TORS BOT reduction and lingual tonsillectomy for treatment of pediatric OSAHS.
Methods:
This was a retrospective study of nine patients (5 non-syndromic; 4 syndromic) who underwent isolated BOT reduction and lingual tonsillectomy for OSAHS between 2012 and 2014 at a tertiary care pediatric medical center. Differences between pre and post surgical polysomnograms (PSGs) were utilized to measure the procedural effectiveness. Patient age, sex, body mass index (BMI), developmental status, and comorbid conditions were also examined.
Results:
The average patient age was 10.5 years (range 5.2-18.5). There were 5 males and 4 females. The mean pre-operative obstructive AHI (O-AHI) was 27.1 compared to 10.9 post-operatively (mean difference=16.1, t=2.27, p≤0.05). Statistically significant reductions were also noted in hypopneic events (mean difference=61.3, t=2.64, p<0.05) and lowest oxygen saturation (mean difference=9.0, t=-3.29, p≤0.01). One patient developed a post-operative bleed that was controlled operatively.
Conclusions:
In children with airway obstruction associated with BOT and lingual tonsillar hypertrophy, TORS is a useful and effective tool. Patients' who underwent TORS demonstrated a significant decrease in obstructive events. All patients reviewed exhibited at least a 50% reduction in O-AHI.
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