Pediatric Sleep Surgery

Sulman, Cecille G.

doi:10.3389/fped.2014.00051

Cited by 12 publications

(7 citation statements)

References 88 publications

(107 reference statements)

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“…34,35 Risks and complications of adenotonsillectomy include postoperative hemorrhage; dehydration; temporary or permanent lingual or hypoglossal nerve injury with tongue numbness, weakness, or altered taste and sensation; injury to the carotid artery; glossopharyngeal nerve injury; regrowth of the lymphoid tissue, necessitating revision surgery; velopharyngeal insufficiency; injury to the torus tubarius, resulting in Eustachian tube dysfunction; and nasopharyngeal stenosis. [36][37][38] Pharyngeal and palate surgery…”

Section: Patient Selection and Evaluationmentioning

confidence: 99%

Surgical management of sleep-disordered breathing in children

Qualls

Rimell

2015

Operative Techniques in Otolaryngology-Head and Neck Surgery

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Section: Patient Selection and Evaluationmentioning

confidence: 99%

Surgical management of sleep-disordered breathing in children

Qualls

Rimell

2015

Operative Techniques in Otolaryngology-Head and Neck Surgery

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“…Evidence of multilevel collapse was observed in 11 (10.4%) patients (Table 1 The mean preoperative oAHI (SD) was 29.7 (25). The mean postoperative oAHI (SD) was 6.6 (6). The mean length of time between surgery and postoperative PSG (SD) was 4.2 months (2.8).…”

Section: Resultsmentioning

confidence: 98%

“…It has been shown that between 15% and 20% of children are found to have persistent OSA refractory to primary AT 2,4,5 . This rate of persistent OSA is likely due to obesity and other factors which cause increased upper airway obstruction 5–7 . Surgical treatments for persistent OSA unresolved after AT include lingual tonsillectomy, septoplasty, supraglottoplasty, base of tongue resection, pharyngoplasty, and uvulopalato‐pharynoplasty 6 .…”

Section: Introductionmentioning

confidence: 99%

“…[5][6][7] Surgical treatments for persistent OSA unresolved after AT include lingual tonsillectomy, septoplasty, supraglottoplasty, base of tongue resection, pharyngoplasty, and uvulopalato-pharynoplasty. 6 Drug-induced sleep endoscopy (DISE) is useful for identifying sites of obstruction prior to surgery by providing direct visualization of the upper airway during anesthesia. 8 DISE has been demonstrated to safely and effectively aid in determining the location and degree of upper airway obstruction, with moderate to substantial interrater reliability and good test re-test reliability.…”

mentioning

confidence: 99%

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Drug‐induced sleep endoscopy effect on intraoperative decision making in pediatric sleep surgery: A 2‐year follow up

Frederick

Brandt

Sheyn

2022

Laryngoscope Investig Oto

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Objective: To further demonstrate sleep endoscopy's utility in improving surgical outcomes for pediatric OSA.Methods: This is a retrospective review of surgically naïve patients <18 years old with diagnosed moderate-severe OSA who underwent DISE at the time of initial sleep surgery.Patients included in final analysis had both preoperative and postoperative polysomnograms. Surgical success was defined as an oAHI decrease by at least one diagnostic category. Residual OSA was defined as any patient with postoperative oAHI >1.Results: A total of 106 patients had preoperative and postoperative polysomnograms. Patients with comorbidities comprised 53.8% of the group. Average BMI% was 88.2, with 75.5% classified as obese. The most common area of collapse was the base of tongue, occurring in 32.1% of patients. There was a statistically significant decrease from the mean preoperative oAHI of 29.7 to the mean postoperative oAHI of 6.6 (p < 0.001). Surgical success occurred in 76.4% of patients. A postoperative oAHI of <5 was achieved in 57.7% of patients with moderate or severe OSA. The average BMI% of patients who met surgical success was 86.4, while the average BMI % of patients who did not was 90.8. A postoperative oAHI of <5 was achieved in 68.4% of patients with a BMI% < 85, compared with 55.2% of patients with a BMI% ≥ 85. Conclusion:This study supports the utilization of DISE during initial surgery for severe sleep apnea in the pediatric population. It was found to effectively aid in significantly reducing surgically naïve patients' mean oAHI.

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“…Indeed, our results demonstrated an indirect correlation between the pharyngeal volume and BMI: the lower the BMI, the greater the increase in pharyngeal volume. This finding could be explained by the presence of adipose tissue deposits near the pharynx and neck, which generally contribute to obstructive sleep syndromes in obese children 17 , as well as by increased circulating levels of inflammatory mediators 18 . Although the observed correlation was only fair, this finding is reasonable given the small sample size and the existence of several other factors that may be involved in determining airway width and collapse.…”

Section: Discussionmentioning

confidence: 99%

Is the difference in the volume of the pharyngeal space, as measured by acoustic pharyngometry, before and after tonsillectomy proportional to the volume of the excised tonsils?

Francesco¹,

Kreibich²

2016

Clinics

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OBJECTIVE:Adenotonsillectomy is recognized as an effective therapy for snoring and sleep disorders in children. It is important to understand whether adenotonsillectomy significantly increases the volume of the pharyngeal space. The goal of this study was to evaluate the change in oropharyngeal volume after adenotonsillectomy and the correlation of this change with the objective volume of the tonsils and body mass index.METHODS:We included 27 subjects (14 males) with snoring caused by tonsil and adenoid hypertrophy. The mean age of the subjects was 7.92 (±2.52) years. Children with craniofacial malformations or neuromuscular diseases or syndromes were excluded. The parents/caregivers answered an adapted questionnaire regarding sleep-disordered breathing. All patients were subjected to weight and height measurements and body mass index was calculated. The subjects underwent pharyngometry before and after adenotonsillectomy and the volume of both excised tonsils together was measured in cm3 in the operating room.RESULTS:Pharyngometric analysis showed that the mean pharyngeal volume was 28.63 (±5.57) cm3 before surgery and 31.23 (±6.76) cm3 after surgery; the volume of the oropharynx was significantly increased post-surgery (p=0.015, Wilcoxon test). No correlation was found between the objective tonsil volume and the post-surgical volume increase (p=0.6885). There was a fair correlation between the oropharyngeal volume and body mass index (p=0.0224).CONCLUSION:Adenotonsillectomy increases the volume of the pharyngeal space, but this increase does not correlate with the objective tonsil size. Furthermore, greater BMI was associated with a smaller increase in the pharyngeal volume. Oropharyngeal structures and craniofacial morphology may also play a role in the increase in oropharyngeal volume.

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Pediatric Sleep Surgery

Cited by 12 publications

References 88 publications

Surgical management of sleep-disordered breathing in children

Surgical management of sleep-disordered breathing in children

Drug‐induced sleep endoscopy effect on intraoperative decision making in pediatric sleep surgery: A 2‐year follow up

Is the difference in the volume of the pharyngeal space, as measured by acoustic pharyngometry, before and after tonsillectomy proportional to the volume of the excised tonsils?

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