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Arch Otolaryngol Head Neck Surg. 2010 Oct;136(10):983-7. doi: 10.1001/archoto.2010.178.

Evolving therapies to treat retroglossal and base-of-tongue obstruction in pediatric obstructive sleep apnea.

Author information

  • 1Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. christopher.t.wootten@vanderbilt.edu

Abstract

OBJECTIVE:

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 board-approved 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 apnea-hypopnea index improved from 14.1 to 6.4 events per hour (P < .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.

PMID:
20956744
[PubMed - indexed for MEDLINE]
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