Swallowing outcomes after pediatric epiglottopexy

Area of Science:

• Otolaryngology
• Pediatric Sleep Medicine
• Surgical Innovation

Background:

• Persistent obstructive sleep apnea (OSA) in children post-tonsillectomy/adenoidectomy necessitates further investigation.
• Common sites of residual upper airway obstruction include the base of the tongue, lingual tonsils, and epiglottic prolapse.
• Surgical options like base of tongue reduction and lingual tonsillectomy with epiglottopexy are considered based on obstruction site.

Purpose of the Study:

• To evaluate the impact of epiglottopexy combined with lingual tonsillectomy on swallowing outcomes in pediatric patients.
• To assess the efficacy of this surgical approach in managing persistent obstructive sleep apnea.

Main Methods:

• Retrospective case series review of pediatric patients undergoing epiglottopexy with lingual tonsillectomy via coblation.
• Preoperative and postoperative assessments included polysomnography (sleep study), sleep endoscopy, and comprehensive swallowing evaluations.
• Functional endoscopic evaluation of swallowing (FEES) was utilized to assess aspiration and penetration.

Main Results:

• Five children with obstructive sleep apnea underwent epiglottopexy with lingual tonsillectomy.
• Significant improvement in sleep apnea was observed, with the Apnea Hypopnea Index (AHI) decreasing from 4.6 to 0.5 (p < 0.05).
• All patients demonstrated normal postoperative swallowing function, with FEES showing no signs of aspiration or penetration.

Conclusions:

• Epiglottopexy with lingual tonsillectomy is a safe and effective surgical technique for improving obstructive sleep apnea in pediatric patients.
• The procedure does not adversely affect swallowing mechanisms.
• The epiglottis maintains its crucial laryngeal protective role post-surgery.