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Updated: Aug 30, 2026
Drug-Induced Sleep Endoscopy (DISE) with Target Controlled Infusion (TCI) and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
Adjunctive pillar suturing or pharyngoplasty in pediatric adenotonsillectomy for obstructive sleep apnea: A
Che-Yi Lin1, Pey-Yu Chen2, Gurpreet S Ahuja3
1Department of Otolaryngology Head and Neck Surgery, National Taiwan University Hospital and Children's Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Division of Otolaryngology and Head and Neck Surgery, CHOC Children's Hospital of Orange County, Orange, CA, USA.
Objective:
To evaluate whether pillar suturing or pharyngoplasty added to tonsillectomy with or without adenoidectomy provides additional benefit in children with obstructive sleep apnea (OSA).
Data Sources:
PubMed, Embase, and the Cochrane Library were systematically searched from database inception to October 2025.
Review Methods:
Randomized controlled trials and nonrandomized comparative studies comparing tonsillectomy with adjunctive pharyngoplasty or pillar suturing versus tonsillectomy alone in pediatric OSA were included. Primary outcomes were polysomnography-derived parameters, including apnea-hypopnea index (AHI), oxygen desaturation index, respiratory disturbance index, and minimum oxygen saturation. Secondary outcomes included OSA-18 scores, clinical efficacy, and postoperative complications. Pooled analyses were performed using random-effects models.
Results:
Eleven studies were included. Meta-analysis showed no significant difference in postoperative AHI between groups (mean difference, 2.22 events/hour; 95% CI, -4.36 to 8.80). No significant differences were observed in postoperative AHI <1 event/hour (odds ratio [OR], 0.75; 95% CI, 0.33 to 1.72), surgical success, or OSA-18 scores. Postoperative hemorrhage risk was also comparable (OR, 0.50; 95% CI, 0.13 to 1.89). Sensitivity analyses excluding studies enrolling children with Down syndrome yielded consistent findings.
Conclusion:
Current evidence does not demonstrate a consistent additional benefit of adjunctive pharyngoplasty or pillar suturing in pediatric OSA surgery. These findings do not support routine adjunctive pharyngeal suturing and underscore the importance of individualized surgical decision-making.
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