This paper looks at the surgical management of OSA in children and approaches the method of patient selection initially. They discuss the role of polysomnography in that it is part of the AAOHNS criteria in those patients with OSA symptoms and obesity, trisomy 21, craniofacial abnormalities, neuromuscular disorders etc., or if symptom correlation is poor with no co-morbidities. However, it is often underutilised due to time and resources therefore overnight pulse oximetry is commonly used instead. In the context of symptoms suggestive of OSA and a positive oximetry result, the positive predictive value is very high at 97%. Once selection has taken place and the obstruction level identified, surgery in children can then take the format of adenotonsillectomy, palate or pharyngeal surgery, tongue base surgery, nasal surgery or laryngomalacia surgery. The authors outline the benefits of adenotonsillectomy in lymphoid hyperplasia [treatment success in 59-82% (AHI<5)] and summarise the various techniques that may be employed to remove them or reduce their volume. Suturing the anterior and posterior tonsillar pillars together reduces the AHI but fails to resolve the OSA. In tongue base surgery, lingual tonsillectomy has been performed in children with laser or radiofrequency ablation and lingual hypertrophy is commonly found in obesity and trisomy 21. Tongue base suspension has also been described in children. Inferior turbinate reduction can be undertaken, often with coblator or microdebrider and laryngomalacia surgery can sometimes help if it is a contributing factor in OSA. This article is a useful overview for the surgical alternatives to children with OSA.

Surgical management of sleep-disordered breathing in children.
Qualls H, Rimell F.
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Suzanne Jervis

FRCS (ORL HNS), Shrewsbury and Telford Hospitals, NHS Trust, UK.

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