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


METHODS
Retrospective institutional review board-approved analysis of 31 operations.


METHODS
Tertiary pediatric medical center.


METHODS
Thirty-one patients with a mean age of 11.5 years (age range, 3.1-23.0 years).


METHODS
Combined genioglossus advancement and radiofrequency ablation.


METHODS
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.
Wootten
Christopher T
CT
Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. christopher.t.wootten@vanderbilt.edu
Shott
Sally R
SR
D000293:Adolescent; D017115:Catheter Ablation; D002648:Child; D002675:Child, Preschool; D004314:Down Syndrome / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D019647:Oral Surgical Procedures; D010092:Oximetry; D010100:Oxygen / Q000097:blood; D017286:Polysomnography; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D014059:Tongue / Q000601:surgery*; D014068:Tonsillectomy; D055815:Young Adult
D010100:Oxygen