Tongue base suspension in children with cerebral palsy and obstructive sleep apnea.
OBJECTIVE
Children with cerebral palsy (CP) are commonly affected by obstructive sleep apnea (OSA). This study examines the efficacy of combined surgical techniques for OSA including tongue base suspension (TBS), using perioperative polysomnograms (PSG) in pediatric patients with CP.


METHODS
Case series with outcome analysis.


METHODS
University based tertiary care children's hospital.


METHODS
A 7-year retrospective chart review of children with CP who underwent surgical management for OSA. Surgical procedures, postoperative complications, and perioperative PSG data were examined. Only patients with both preoperative and postoperative PSG results were included in the study. Based upon procedures performed patients fell into 2 equal groups for analysis.


RESULTS
Fourteen children were identified. Seven patients (mean age = 6.0 years) underwent combined adenotonsillectomy (T&A), uvulopalatopharyngoplasty (UPPP), and tongue base suspension (TBS). Another 7 patients (mean age = 6.3 years) underwent T&A and UPPP alone. Those who received TBS had a mean preoperative AHI of 27.2 compared to 6.8 in the group that did not have TBS. The AHI decreased by a mean of 16.5 in the TBS group and 5.0 in the non-TBS group. The mean oxygen saturation nadir improved in both the TBS (74.0-84.0) and non-TBS (64.8-84.6) groups. The arousal index also improved in the TBS (33.1-20.7) and non-TBS (11.0-5.8) groups. No surgical complications occurred.


CONCLUSIONS
This study suggests that concomitant surgical approaches for OSA in children with CP are effective. Moderate to severe OSA in this population may safely benefit from the added technique of tongue base suspension.
University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Department of Otolaryngology-Head and Neck Surgery, Little Rock, AR 72202, United States. ldhartzell@uams.edu
Larry David
LD
Hartzell
Ryan M
RM
Guillory
Patrick David
PD
Munson
Andrew K
AK
Dunham
Charles Michael
CM
Bower
Gresham Thomas
GT
Richter
D000293:Adolescent; D002547:Cerebral Palsy / Q000150:complications / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007830:Larynx / Q000601:surgery*; D008297:Male; D010159:Palate / Q000601:surgery*; D010614:Pharynx / Q000601:surgery*; D017286:Polysomnography; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D014059:Tongue / Q000601:surgery*; D016896:Treatment Outcome; D014609:Uvula / Q000601:surgery*