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.
Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. christopher.t.wootten@vanderbilt.edu
Christopher T
CT
Wootten
Sally R
SR
Shott
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