Lingual tonsils hypertrophy; a cause of obstructive sleep apnea in children after adenotonsillectomy: Operative problems and management

Surgical management of sleep-disordered breathing in children

“…[43][44][45][46] Tongue base surgery Lingual tonsil hypertrophy has been associated with persistent OSA after adenotonsillectomy and is more common in children with obesity or trisomy 21. [47][48][49] Lingual tonsillectomy has been performed in adults with electrocautery, laser, and radiofrequency ablation, and in children, with laser or radiofrequency ablation. Lingual tonsillectomy is performed by retracting the tongue with a clamp or silk stitch, exposing the tongue base with a conventional laryngoscope or GlideScope, marking the site of the lingual arteries and hypoglossal nerves, then ablating the hypertrophic lingual tonsil tissue.…”

“…Lingual tonsillectomy is performed by retracting the tongue with a clamp or silk stitch, exposing the tongue base with a conventional laryngoscope or GlideScope, marking the site of the lingual arteries and hypoglossal nerves, then ablating the hypertrophic lingual tonsil tissue. 48,49 One approach involves a small anterior tongue incision, tunneling posteriorly, and submucosally ablating the hypertrophic tissue. 50 Midline posterior glossectomy has been used in drug-induced sleep endoscopy-directed treatment of pediatric OSA.…”

“…Lymphatic and vascular malformations of the oral cavity, tongue, pharynx, and airway may be other causes of obstruction. 48,61 Additionally, there are cases of laryngeal lesions causing obstructive sleep apnea in neurofibromatosis. 68 Tracheostomy is employed if other surgical interventions are inadequate, severe neurologic comorbidities are present, or the airway is obstructed when the patient is awake.…”

Pediatric Sleep Surgery

“…Figure 3 demonstrates lingual tonsil hypertrophy in a child who presented with obstructive sleep apnea after adenotonsillectomy. Lingual tonsillectomy may be performed with sharp dissection, monopolar dithermy (66), laser (67), or coblation (12, 54). The anterior midline of the tongue is controlled with a heavy silk suture, while an appropriately sized laryngoscope is used to expose the tongue base during lingual tonsillectomy (12).…”

“…Comparison of pre-operative and post-operative PSG demonstrated statistically significant reductions in the respiratory distress index (12). Complications related to lingual tonsillectomy include edema (67) and adhesions between the epiglottis and tongue base (68). …”