title: Characterization of obstructive sleep apnea before and after tongue-lip adhesion in children with micrognathia.
abstract: OBJECTIVE
  To characterize airway obstruction before and after tongue-lip adhesion in children with micrognathia using polysomnography.
  
  
  METHODS
  Retrospective pilot case series.
  
  
  METHODS
  Evaluation of all children with micrognathia who underwent tongue-lip adhesion and polysomnography before and after surgery from 2002 to 2007 (N  =  8).
  
  
  RESULTS
  Eight children met inclusion criteria; six were girls. The mean interval between polysomnography and tongue-lip adhesion was 6 days (range, 2 to 13 days) preoperatively and 17 days (range, 5 to 32 days) postoperatively. Severe obstructive sleep apnea was identified in seven of eight (88%) children, with a mean preoperative obstructive apnea hypopnea index of 52.6 events per hour (range, 7.1 to 85.7 events per hour). None had significant central sleep apneas (>5 per hour). Tongue-lip adhesion resulted in a mean decrease of 34.5 events per hour (range, -65.8 to 71.6 events per hour). After tongue-lip adhesion, seven of eight (87.5%) patients had an improved obstructive apnea hypopnea index, with resolution of obstructive sleep apnea in one child and improvement to mild (two) and moderate (two) obstructive sleep apnea in four others. Only one child had an obstructive apnea hypopnea index that increased after tongue-lip adhesion. Peak end-tidal pCO(2) measurements were elevated in all eight children before surgery at a mean of 60 mm Hg (range, 52 to 76 mm Hg) that improved to 51 mm Hg (range, 45 to 59 mm Hg), with normal peak levels in four children. Oxygen saturation nadir improved from 73% (range, 58% to 81%) to 82% (range, 65% to 94%).
  
  
  CONCLUSIONS
  Tongue-lip adhesion may be performed in micrognathic infants to alleviate airway obstruction. Polysomnographic evaluation in this pilot study before and after surgery suggests that tongue-lip adhesion usually improves obstructive sleep apnea, but only 38% had complete resolution. Future studies of tongue-lip adhesion efficacy should include polysomnographic evaluation.
authors.affiliation: Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine, 601 North Caroline Street, Room 6231, Baltimore, MD 21287, USA.
authors.forename: Ahmad R
authors.initials: AR
authors.lastname: Sedaghat
authors.forename: Iee Ching W
authors.initials: IC
authors.lastname: Anderson
authors.forename: Brian M
authors.initials: BM
authors.lastname: McGinley
authors.forename: Mark I
authors.initials: MI
authors.lastname: Rossberg
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Redett
authors.forename: Stacey L
authors.initials: SL
authors.lastname: Ishman
mesh_terms: D005260:Female; D006801:Humans; D007223:Infant; D008046:Lip / Q000601:surgery*; D008297:Male; D008844:Micrognathism / Q000150:complications* / Q000601:surgery*; D019647:Oral Surgical Procedures; D010855:Pierre Robin Syndrome / Q000150:complications* / Q000601:surgery*; D010865:Pilot Projects; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000209:etiology* / Q000601:surgery*; D014059:Tongue / Q000601:surgery*; D016896:Treatment Outcome