Pediatric Tongue Base Surgery

摘要

Tongue base obstruction (TBO) is a common cause of persistent obstructive sleep apnea (OSA) after removal of adenoids and tonsils in children, particularly in those with rapid eye movement (REM) or supine-dominant OSA. The tongue is part of the collapsible pharyngeal airway and most amenable to collapse because of either loss of genioglossus tone during REM sleep or gravity-dependent collapse into the oropharyn-geal airway during sleeping in the supine position. The tongue base, defined as the posterior one-third of the tongue from the circumvallate papillae to the vallecula, comprises both tongue musculature and the lingual tonsil (LT). The degree of TBO depends on 2 factors: LT hypertrophy and glossoptosis; sometimes both coexist. Obstruction of the laryngeal airway can be caused by either or both glossoptosis (retrograde collapse of the tongue) and LT hypertrophy. The most common risk factors for LT hypertrophy include Down syndrome, obesity, and significant allergies. In addition, children with Down syndrome have macroglossia and glossoptosis resulting in significant TBO. Removal of LT and/or reduction in tongue base bulk can increase the retrolingual space and minimize the obstructive tendencies over the laryngeal inlet. Persistence of nasal obstruction may increase the negative pressure in the pharyngeal airway leading to worsening of the tongue base collapse; hence, it is critical to simultaneously assess and treat significant nasal obstruction.