Tongue Reduction for Pediatric Obstructive Sleep Apnea: A Systematic Review.

Abstract

Objective: Obstructive sleep apnea (OSA) is a prevalent pediatric disorder that, if untreated, can result in substantial developmental and health consequences. Tongue reduction procedures, such as midline posterior glossectomy (MPG), are increasingly used to address tongue base obstruction. This systematic review evaluates the effectiveness and safety of tongue reduction procedures for pediatric OSA.

Data sources: Embase, PubMed, and Web of Science databases were queried for studies from inception to September 20, 2023.

Review methods: Studies reporting on outcomes of pediatric patients (≤21 years) undergoing tongue reduction surgery for OSA were included.

Results: From 477 abstracts, 9 studies met the inclusion criteria, representing 146 pediatric patients. Surgical techniques included MPG, transoral robotic-assisted tongue base resection, and keyhole partial glossectomy. Primary outcomes assessed were apnea-hypopnea index (AHI), minimum oxygen saturation, and adverse events. All studies reported a reduction in AHI and increased minimum oxygen saturation following tongue reduction despite the method. Adverse events appear to be rare but included postoperative bleeding, need for reintubation, and wound dehiscence.

Conclusion: Tongue reduction procedures appear to be safe and effective for managing pediatric OSA, improving key clinical outcomes. However, long-term results, comparative studies of surgical techniques, and refined patient selection criteria are needed. Future research should also identify risk factors for persistent OSA following tongue base reduction. These findings suggest that tongue reduction is a valuable addition to the treatment arsenal for pediatric OSA.