Swallowing outcomes after pediatric epiglottopexy.

INTRODUCTION

Persistent sleep apnea following tonsillectomy and adenoidectomy in children requires additional evaluation. One of the common areas of persistent upper airway obstruction in these children is the base of the tongue and lingual tonsils as well as epiglottic prolapse. Depending on the site of obstruction on sleep endoscopy or a cine MRI, surgical procedures include base of tongue reduction and lingual tonsillectomy with or without epiglottopexy.

OBJECTIVE

To assess the swallowing outcomes in children undergoing epiglottopexy with lingual tonsillectomy.

METHODS

A retrospective case series review of children undergoing epiglottopexy with or without lingual tonsillectomy. All patients underwent an epiglottopexy with lingual tonsillectomy using coblation. A detailed evaluation including a sleep study, sleep endoscopy, and thorough swallowing assessment preoperatively as well as postoperatively was performed.

RESULTS

Five children underwent epiglottopexy with lingual tonsillectomy for obstructive sleep apnea. Epiglottopexy improved sleep apnea with Apnea Hypopnea Index (AHI) falling significantly from 4.6 to 0.5 (p < 0.05). All patients had a normal swallowing assessment postoperatively with functional endoscopic evaluation of swallowing (FEES) revealing no evidence of aspiration and penetration.

CONCLUSION

In our case series epiglottopexy with lingual tonsillectomy is a safe and effective technique, which improves sleep apnea in pediatric patients. It does not affect the swallowing mechanism, and the epiglottis still retains the laryngeal protective role.