Outcomes of Tongue Base Reduction and Lingual Tonsillectomy for Residual Pediatric Obstructive Sleep Apnea after Adenotonsillectomy

Ulualp, Seckin O.

doi:10.1055/s-0039-1685156

Cited by 15 publications

(5 citation statements)

References 33 publications

(58 reference statements)

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“…Evidence supporting this can be found in the study by Park et al, 85 which demonstrated a significant improvement in OSA‐18 QOL scores in children with hypotonia after DISE‐directed surgery. Subjectively, DISE‐directed surgery has also been found to improve patient‐reported symptoms such as snoring, pauses in breathing, gasping for air, mouth breathing, daytime somnolence, sleepwalking, sleep talking, teeth grinding, enuresis, and feeling tired 87 . Future prospective studies on pediatric DISE‐directed surgery should include validated QOL and symptom scores when assessing outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Subjectively, DISE-directed surgery has also been found to improve patient-reported symptoms such as snoring, pauses in breathing, gasping for air, mouth breathing, daytime somnolence, sleepwalking, sleep talking, teeth grinding, enuresis, and feeling tired. 87 Future prospective studies on pediatric DISE-directed surgery should include validated QOL and symptom scores when assessing outcomes.…”

Section: Outcomes Of Dise-directed Surgerymentioning

confidence: 99%

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Expert Consensus Statement: Pediatric Drug‐Induced Sleep Endoscopy

Baldassari

Lam

Ishman

et al. 2021

Otolaryngol.--head neck surg.

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Objective To develop an expert consensus statement on pediatric drug-induced sleep endoscopy (DISE) that clarifies controversies and offers opportunities for quality improvement. Pediatric DISE was defined as flexible endoscopy to examine the upper airway of a child with obstructive sleep apnea who is sedated and asleep. Methods Development group members with expertise in pediatric DISE followed established guidelines for developing consensus statements. A search strategist systematically reviewed the literature, and the best available evidence was used to compose consensus statements regarding DISE in children 0 to 18 years old. Topics with significant practice variation and those that would improve the quality of patient care were prioritized. Results The development group identified 59 candidate consensus statements, based on 50 initial proposed topics, that focused on addressing the following high-yield topics: (1) indications and utility, (2) protocol, (3) optimal sedation, (4) grading and interpretation, (5) complications and safety, and (6) outcomes for DISE-directed surgery. After 2 iterations of the Delphi survey and removal of duplicative statements, 26 statements met the criteria for consensus; 11 statements were designated as no consensus. Several areas, such as the role of DISE at the time of adenotonsillectomy, were identified as needing further research. Conclusion Expert consensus was achieved for 26 statements pertaining to indications, protocol, and outcomes for pediatric DISE. Clinicians can use these statements to improve quality of care, inform policy and protocols, and identify areas of uncertainty. Future research, ideally randomized controlled trials, is warranted to address additional controversies related to pediatric DISE.

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Section: Discussionmentioning

confidence: 99%

Section: Outcomes Of Dise-directed Surgerymentioning

confidence: 99%

Expert Consensus Statement: Pediatric Drug‐Induced Sleep Endoscopy

Baldassari

Lam

Ishman

et al. 2021

Otolaryngol.--head neck surg.

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“… 40 And craniofacial or dentoalveolar aesthetics of patients with Trisomy 21 can be improved with surgical procedures and orthodontic treatments. 35 , 41 …”

Section: The Physiological Growth and Developmental Anomalied Of Nerv...mentioning

confidence: 99%

The interaction between the nervous system and the stomatognathic system: from development to diseases

et al. 2023

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The crosstalk between the nerve and stomatognathic systems plays a more important role in organismal health than previously appreciated with the presence of emerging concept of the “brain-oral axis”. A deeper understanding of the intricate interaction between the nervous system and the stomatognathic system is warranted, considering their significant developmental homology and anatomical proximity, and the more complex innervation of the jawbone compared to other skeletons. In this review, we provide an in-depth look at studies concerning neurodevelopment, craniofacial development, and congenital anomalies that occur when the two systems develop abnormally. It summarizes the cross-regulation between nerves and jawbones and the effects of various states of the jawbone on intrabony nerve distribution. Diseases closely related to both the nervous system and the stomatognathic system are divided into craniofacial diseases caused by neurological illnesses, and neurological diseases caused by an aberrant stomatognathic system. The two-way relationships between common diseases, such as periodontitis and neurodegenerative disorders, and depression and oral diseases were also discussed. This review provides valuable insights into novel strategies for neuro-skeletal tissue engineering and early prevention and treatment of orofacial and neurological diseases.

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“…Similar to our findings, previous studies documented upper airway obstruction due to the tongue or epiglottis in surgically naïve children with OSA as well as in children with residual OSA. 18,19 Drug-induced sleep endoscopy facilitates targeted surgical approaches and individualized surgical treatments while avoiding failures after TA. 18,[20][21][22][23][24][25] The use of DISE at the time of TA in surgically naïve infants and children with OSA altered the surgical decision making in 35% of infants and in 24% of older children.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Effect of Tonsillectomy and Adenoidectomy on Upper Airway Obstruction Patterns in Children with Obstructive Sleep Apnea

Mothersole

Ulualp

Szmuk

et al. 2023

Int Arch Otorhinolaryngol

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Introduction Alterations in upper airway flow dynamics and sites of airway obstruction immediately after tonsillectomy and adenoidectomy (TA) have not been assessed. Identification of the changes in airway obstruction patterns after TA potentially improves the surgical management of children with obstructive sleep apnea (OSA). Objective To evaluate the effect of TA on upper airway obstruction patterns detected with drug-induced sleep endoscopy (DISE). Methods The medical records of patients who underwent pre-TA DISE during the induction of anesthesia and post-TA DISE at the end of TA were reviewed. Data pertaining to polysomnography and DISE findings were analyzed. Results Twenty-seven patients (15 male and 12 females aged between 2 and 18 years old) were identified. All patients had obstruction at multiple sites of the upper airway. Prior to TA, airway obstruction was at the level of the velum in 27 patients, of the oropharynx/lateral walls in 27, of the tongue in 7, and of the epiglottis in 4. After TA, airway obstruction was at the level of the velum in 24 patients, of the oropharynx/lateral walls in 16, of the tongue in 6, and of the epiglottis in 4. The degree of obstruction at the levels of the velum and oropharynx/lateral walls after TA was significantly decreased. Conclusions Drug-induced sleep endoscopy performed prior to TA revealed that most of the sites of airway obstruction persisted after TA in OSA children with multiple sites of airway obstruction. Further studies in larger group of children with OSA are needed to establish the value of DISE findings in predicting residual OSA after TA, surgical planning, determining the need for post TA sleep study, and counseling caregivers.

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Outcomes of Tongue Base Reduction and Lingual Tonsillectomy for Residual Pediatric Obstructive Sleep Apnea after Adenotonsillectomy

Cited by 15 publications

References 33 publications

Expert Consensus Statement: Pediatric Drug‐Induced Sleep Endoscopy

Expert Consensus Statement: Pediatric Drug‐Induced Sleep Endoscopy

The interaction between the nervous system and the stomatognathic system: from development to diseases

The Effect of Tonsillectomy and Adenoidectomy on Upper Airway Obstruction Patterns in Children with Obstructive Sleep Apnea

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