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European Archives of Oto-Rhino-Laryngology

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01-08-2017 | Review Article

Tongue surgeries for pediatric obstructive sleep apnea: a systematic review and meta-analysis

Authors: Macario Camacho, Michael W. Noller, Soroush Zaghi, Lauren K. Reckley, Camilo Fernandez-Salvador, Erika Ho, Brandyn Dunn, Dylan Chan

Published in: European Archives of Oto-Rhino-Laryngology | Issue 8/2017

Abstract

Objectives

To evaluate the international literature for studies reporting outcomes for obstructive sleep apnea (OSA) in children undergoing isolated tongue surgeries.

Methods

Two authors searched from inception through November 14, 2016 in four databases including PubMed/MEDLINE.

Results

351 studies were screened. Eleven studies (116 children) met criteria. Most children were syndromic and had craniofacial disorders, co-morbidities, or other serious medical issues. Surgeries included base-of-tongue (BOT) reduction (n = 114), tongue suspension (n = 1), and hypoglossal nerve stimulation (n = 1). The pre- and post-BOT reduction surgeries decreased apnea–hypopnea index (AHI) from a mean (M) and standard deviation (SD) of 16.9 ± 12.2/h to 8.7 ± 10.6/h (48.5% reduction) in 114 patients. Random effects modeling (109 patients) demonstrated a standardized mean difference for AHI of −0.78 (large magnitude of effect) [95% CI −1.06, −0.51], p value <0.00001. For BOT surgery in 53 non-syndromic children, the AHI decreased 59.2% from 14.0 ± 11.4 to 5.7 ± 6.7/h, while in 55 syndromic children, the AHI decreased 40.0% from 20.5 ± 19.1 to 12.3 ± 18.2/h. BOT reduction improved lowest oxygen saturation from M ± SD of 84.7 ± 7.4–87.9 ± 6.5% in 113 patients. Hypoglossal nerve stimulation and tongue-base suspension are limited to case reports.

Conclusions

Most children undergoing tongue surgeries in the literature were syndromic and had craniofacial disorders, co-morbidities, or other serious medical issues. Children with a body mass index <25 kg/m² and non-syndromic children have had the most improvement in AHI. The specific type of surgery must be tailored to the patient. Patients with co-morbidities should undergo treatment in centers that are equipped to provide appropriate perioperative care.

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Title: Tongue surgeries for pediatric obstructive sleep apnea: a systematic review and meta-analysis
Authors: Macario Camacho
Michael W. Noller
Soroush Zaghi
Lauren K. Reckley
Camilo Fernandez-Salvador
Erika Ho
Brandyn Dunn
Dylan Chan
Publication date: 01-08-2017
Publisher: Springer Berlin Heidelberg
Published in: European Archives of Oto-Rhino-Laryngology / Issue 8/2017
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-017-4545-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Tongue surgeries for pediatric obstructive sleep apnea: a systematic review and meta-analysis

Abstract

Objectives

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

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