Evolving Therapies to Treat Retroglossal and Base-of-Tongue Obstruction in Pediatric Obstructive Sleep Apnea

Abstract

To describe our experience treating retroglossal and base-of-tongue collapse in children and young adults with obstructive sleep apnea using combined genioglossus advancement (Repose THS; MedtronicENT, Jacksonville, Florida) and radiofrequency ablation of the tongue base. Design: Retrospective institutional review boardapproved analysis of 31 operations. Setting: Tertiary pediatric medical center. Patients: Thirty-one patients with a mean age of 11.5 years (age range, 3.1-23.0 years). Interventions: Combined genioglossus advancement and radiofrequency ablation. Main Outcome Measures: Preoperative and postoperative polysomnographic data were evaluated for each patient. Success of surgery was determined using the criteria of a postoperative apnea-hypopnea index of 5 or fewer events per hour, without evidence of hypoxemia (oxygen saturation as measured by pulse oximetry), and without prolonged hypercarbia (end-tidal carbon dioxide). Results: Thirty-one patients who underwent genioglossus advancement were analyzed. Nineteen (61%) had Down syndrome. The overall success rate was 61% (19 of 31) (58% [12 of 19] success among patients with Down syndrome and 66% [7 of 12] success among patients without Down syndrome). Overall, the mean apneahypopnea index improved from 14.1 to 6.4 events per hour (PϽ.001); the mean nadir oxygen saturation as measured by pulse oximetry during apnea improved from 87.4% to 90.9% (P=.07). Conclusions: Pediatric obstructive sleep apnea refractory to adenotonsillectomy that is due to retroglossal and base-of-tongue collapse remains difficult to treat. However, most patients in this analysis benefited from combined genioglossus advancement and radiofrequency ablation.

Evaluation of Complex Upper Airway Obstruction in Children Using Cine-MRI: A Single-Center Experience and Literature Review

“…They related that to the significant residual adenoid tissue and increase in the volume of the tongue and soft palate [17]. The above studies and other studies mentioned in Table 4 showed that Cine-MRI can help in exploring the causes of persistent OSA post adenotonsillectomy, especially in Down syndrome and obese patients [8][9][10][11][12][13][14][15][16][17][18][19][20][21].…”

“…They related that to the significant residual adenoid tissue and increase in the volume of the tongue and soft palate [ 17 ]. The above studies and other studies mentioned in Table 4 showed that Cine-MRI can help in exploring the causes of persistent OSA post adenotonsillectomy, especially in Down syndrome and obese patients [ 8 - 21 ]. Cine-MRI can explain the low success rate of adenotonsillectomy in high-risk patients, which can help prospectively in choosing the appropriate surgical approach.…”

Sleep-disordered breathing in children and adults with intellectual disability: mind the gap!

“…Other surgical options that have been reported in children (and young adults with ID) include genioglossus advancement and radiofrequency ablation 44. The patients in this series had OSA refractory to AT that was caused by retroglossal and base-of-tongue collapse.…”

Systematic review of site of obstruction identification and non‐CPAP treatment options for children with persistent pediatric obstructive sleep apnea

“…Authors found significant improvements in oxygen saturation and a decrease in the AHI from 46.5 to 17.4 events per hour, reporting that 84% of patients had correction of respiratory obstruction. Two studies authored by Wootten et al reported on patients who underwent more than one procedure for persistent OSA. In the first, 30 of 31 patients underwent tongue suspension, along with radiofrequency ablation of the base of tongue, and 10 patients underwent additional concurrent procedures.…”

“…These authors reported resolution of OSA in 61% of patients. The second study primarily reported on the results of multilevel surgery, which included various combinations of lingual tonsillectomy, posterior midline glossectomy, revision adenoidectomy, inferior turbinate submucosal resection, uvulopalatopharyngoplasty, and supraglottoplasty. Authors found that the mean AHI decreased from 7.0 to 3.6 events per hour.…”