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. 2022 Mar 14;51(1):11.
doi: 10.1186/s40463-022-00562-0.

Pediatric sleep outcomes after endoscopy-directed simultaneous lingual tonsillectomy and epiglottopexy

Matthew Maksimoski  1 , Sarah E Maurrasse  1   2   3 , Stephen R Hoff  1   2 , Jennifer Lavin  1   2 , Taher Valika  1   2 , Dana M Thompson  1   2 , Jonathan B Ida  4   5
Affiliations

Pediatric sleep outcomes after endoscopy-directed simultaneous lingual tonsillectomy and epiglottopexy

Matthew Maksimoski et al. J Otolaryngol Head Neck Surg. .

Abstract

Background: The purpose of this study was to evaluate the efficacy of sleep endoscopy-directed simultaneous lingual tonsillectomy and epiglottopexy in patients with sleep disordered breathing (SDB), including polysomnography (PSG) and swallowing outcomes.

Methods: A retrospective review was performed of all patients undergoing simultaneous lingual tonsillectomy and epiglottopexy over the study period. PSG objective measures were recorded pre- and postoperatively, along with demographic data, comorbidities, and descriptive data of swallowing dysfunction in the postoperative setting.

Results: A total of 24 patients met inclusion criteria for consideration, with 13 having valid pre- and postoperative PSG data. Successful surgery was achieved in 84.6% of patients, with no difference based on presence of medical comorbidities including Trisomy 21. Median reduction in obstructive apnea-hypopnea index (oAHI) with the procedure was 69.9%. Four patients (16.7%) had postoperative concern for dysphagia, but all objective swallowing evaluations were normal and no dietary modifications were necessary.

Conclusion: Combination lingual tonsillectomy and epiglottopexy in indicated patients has a high rate of success in this single-institutional study without new dysphagia in this population. These procedures are amenable to a combination surgery in appropriately selected patients determined by sleep state endoscopy in the setting of SDB evaluated with drug-induced sleep endoscopy.

Keywords: Airway obstruction; Airway surgery; DISE; Evidence-based medicine; Obstructive sleep apnea; Sleep disordered breathing.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Photodocumentation of lingual tonsillectomy and epiglottopexy operative technique. a Preoperative lingual tonsillar hypertrophy and epiglottic prolapse, b Removal of lingual tonsil tissue with coblation, c Removal of lingual tonsil tissue with microdebrider, d Endoscopic suturing of the base of tongue to the lingual surface of the epiglottis, e Postoperative repositioning of the lingual tonsil-epiglottis complex with a widely patent airway
Fig. 2
Fig. 2
The relationship of the hyoepiglottic—or lingual-epiglottic—ligament (arrow) to the base of tongue makes it an important suspensory support for the epiglottis
See this image and copyright information in PMC

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