Abstract
Objective
1) To describe our experience with a technique of lingual tonsillectomy using coblation with endoscopic visualization. 2) To document its utility for treating children with persistent sleep apnea after adenotonsillectomy who on sleep endoscopy have enlarged lingual tonsils and tongue base obstruction.
Methods
Retrospective cohort study in a tertiary pediatric medical center. Between 2005 and 2007, 20 patients (ages 3 -18), who had a previous adenotonsillectomy (T&A) for obstructive sleep apnea (OSA), were diagnosed with persistent OSA by polysomnography (PSG). These children had both in-office unsedated fiberoptic laryngoscopy and dynamic anesthesia-assisted sleep fiberoptic laryngoscopy, both of which demonstrated lingual tonsillar hypertrophy contributing to tongue base obstruction of the hypopharynx. With a visually confirmed site of lesion, these children underwent endoscopic lingual tonsillectomy for treatment. Pre- and post-operative PSG data were paired and analyzed statistically.
Results
Statistically significant reductions in respiratory distress index (RDI) were observed when pre- and post-operative data were compared (mean 14.9 vs. 7.8, median 12.6 vs. 3.3). There were similar reductions in the number of apneas and hypopneas. The mean and median low O2 saturations did not change significantly.
Conclusions
Endoscopic lingual tonsillectomy is an effective technique for the treatment of lingual tonsillar hypertrophy causing persistent obstructive sleep apnea after T&A. Anesthesia-assisted sleep endoscopy is key to diagnosing the obstructive contribution of the enlarged lingual tonsils. The combination of endoscopic access with the near bloodless technique for ablation of the lingual tonsils provides a consistently reproducible method of treating children with this uncommon problem.
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