Base of Tongue Surgery and Pediatric Obstructive Sleep Apnea

Otolaryngol Head Neck Surg. 2023 Apr;168(4):839-847. doi: 10.1177/01945998221094211. Epub 2023 Feb 5.


Objective: Drug-induced sleep endoscopy-directed lingual tonsillectomy and midline posterior glossectomy have been employed for the treatment of obstructive sleep apnea in children. The purpose of this study is to evaluate outcomes in children undergoing lingual tonsillectomy, midline posterior glossectomy, or combined base of tongue reduction procedures for obstructive sleep apnea.

Study design: Case series with chart review.

Setting: Tertiary care academic medical center.

Methods: A case series was performed with chart review of pediatric patients with obstructive sleep apnea who underwent base of tongue surgery as directed by drug-induced sleep endoscopy. Pre- and postoperative obstructive apnea-hypopnea index (oAHI) was compared. Age, sex, body mass index z score, and medical history were also evaluated.

Results: A total of 168 children were included, with a mean ± SD age of 8.3 ± 3.6 years. Of these patients, 101 underwent lingual tonsillectomy alone; 25, midline posterior glossectomy alone; and 42, both. Their mean oAHI improvement was 3.52 ± 8.39, 2.55 ± 5.59, and 3.70 ± 6.07, respectively. Each surgical group experienced significant improvement in sleep apnea when pre- and postoperative oAHI was compared (P < .01). Overall surgical success, as defined by oAHI <1 (or <5 without clinical symptoms), was 75% (126 patients).

Conclusion: When guided by drug-induced sleep endoscopy, pediatric tongue base surgery can significantly improve oAHI and thus demonstrates promising success in treating pediatric obstructive sleep apnea.

Keywords: drug-induced sleep endoscopy; lingual tonsillectomy; pediatric obstructive sleep apnea; posterior midline glossectomy; tongue base surgery.

MeSH terms

  • Adenoidectomy
  • Child
  • Child, Preschool
  • Glossectomy / methods
  • Humans
  • Oral Surgical Procedures*
  • Retrospective Studies
  • Sleep Apnea, Obstructive* / diagnosis
  • Sleep Apnea, Obstructive* / surgery
  • Tongue / surgery
  • Tonsillectomy* / methods
  • Treatment Outcome