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Lingual Tonsillectomy as Part of a DISE-Directed Multilevel Upper Airway Surgery to Treat Complex Pediatric OSA: A

Cornelia Trandafir1, Vincent Couloigner1,2, Florian Chatelet2,3

  • 1Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
|August 16, 2024
PubMed

Insights

Lingual tonsillectomy (LT) is an effective and safe procedure for treating complex obstructive sleep apnea (OSA) in children. This multilevel surgery significantly reduces the apnea-hypopnea index (AHI), improving sleep quality and potentially allowing for continuous positive airway pressure (CPAP) weaning.

Area of Science:

  • Otolaryngology
  • Pediatric Surgery
  • Sleep Medicine

Background:

  • Obstructive sleep apnea (OSA) in children, particularly complex cases, presents significant management challenges.
  • Multilevel upper airway surgery is often required for severe OSA, but the efficacy of specific procedures like lingual tonsillectomy (LT) needs further evaluation.

Purpose of the Study:

  • To assess the effectiveness of lingual tonsillectomy (LT) as a component of multilevel surgery for complex pediatric obstructive sleep apnea (OSA).
  • To evaluate the safety and clinical outcomes associated with LT in this patient population.

Main Methods:

  • A retrospective case series was conducted at a pediatric tertiary care academic center.
  • Included were children undergoing LT for complex OSA between January 2018 and June 2022, following a protocolized drug-induced sleep endoscopy (DISE).
  • LT was performed as part of a comprehensive surgical approach addressing all identified obstructive sites, with outcomes analyzed using pre- and post-operative sleep studies.

Main Results:

  • The study included 123 children (median age 8 years), with a high prevalence of Down syndrome (53%) and craniofacial malformations (18%).
  • The median apnea-hypopnea index (AHI) significantly decreased from 18 events/h preoperatively to 3 events/h postoperatively (P < .001).
  • Post-surgery, 35% of patients achieved an AHI < 1.5 events/h, 36% had an AHI < 5 events/h, and 57% could be weaned from CPAP. Two patients experienced postoperative hemorrhage, and two required reintubation.

Conclusions:

  • Lingual tonsillectomy, when integrated into a DISE-guided multilevel surgical strategy, demonstrates high efficiency in treating complex pediatric OSA.
  • The procedure is considered safe, with a low rate of significant complications, offering a viable treatment option for children with severe airway obstruction.
Abstract

Keywords:
continuous positive airway pressurepediatric OSAtongue base coblation

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