The safety and efficacy of pediatric lingual tonsillectomy

M A DeMarcantonio; E Senser; J Meinzen-Derr; N Roetting; S Shott; S L Ishman

doi:10.1016/j.ijporl.2016.09.037

The safety and efficacy of pediatric lingual tonsillectomy

Int J Pediatr Otorhinolaryngol. 2016 Dec:91:6-10. doi: 10.1016/j.ijporl.2016.09.037. Epub 2016 Oct 1.

Authors

M A DeMarcantonio¹, E Senser², J Meinzen-Derr³, N Roetting¹, S Shott⁴, S L Ishman⁵

Affiliations

¹ Division of Pediatric Otolaryngology - Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
² University of Cincinnati College of Medicine, Cincinnati, OH, USA.
³ Division of Pediatric Otolaryngology - Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
⁴ Division of Pediatric Otolaryngology - Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
⁵ Division of Pediatric Otolaryngology - Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. Electronic address: stacey.ishman@cchmc.org.

PMID: 27863643
DOI: 10.1016/j.ijporl.2016.09.037

Abstract

Objective: Lingual tonsillar hypertrophy is recognized as a cause of persistent obstructive sleep apnea (OSA) after adenotonsillectomy in children. However, little has been reported regarding the complications, postoperative course and effectiveness of lingual tonsillectomy (LT). Our objective was to review the safety and effectiveness of LT in children.

Methods: Retrospective review of children undergoing LT from January 2009 to December 2015 at a tertiary children's hospital. Complications, postoperative course and polysomnographic (PSG) outcomes were recorded for all patients.

Results: We identified 92 children (mean age = 8.6 years, 50% female) who underwent LT; 43.5% had a syndromic diagnosis. The most common complications were emergency department presentation for bleeding (4.4%) and poor oral intake (3.3%). The readmission rate was 4.4% including 2 children (2.2%) who required operative control of hemorrhage. No children required unplanned reintubation or ICU admission. In children with PSG data (n = 18), the median apnea-hypopnea index (AHI) decreased from 8.5 to 3.8 events/hour (p = 0.022) and the median obstructive AHI (oAHI) decreased from 8.3 to 3.1 events/hour (p = 0.021). In addition, the oxygen saturation nadir increased from 83.8% to 89.0% (p = 0.0007). After surgery the percentage of patients with oAHI<5 events/hour increased from 27.8% to 61.1% (p = 0.08).

Conclusions: Readmission and bleeding rates after lingual tonsillectomy in children were similar to that seen with tonsillectomy. Polysomnographic data showed that lingual tonsillectomy resulted in a significant reduction of both AHI and oAHI with a postoperative oAHI <5 achieved in 61% of patients.

Keywords: Complications; Efficacy; Lingual tonsillectomy; Obstructive sleep apnea; Outcomes; Safety.

MeSH terms

Adolescent
Child
Child, Preschool
Female
Humans
Length of Stay
Male
Palatine Tonsil / surgery*
Polysomnography / methods
Postoperative Complications / epidemiology
Postoperative Period
Retrospective Studies
Sleep Apnea, Obstructive / surgery*
Tonsillectomy / methods*
Treatment Outcome