{"title":"Lingual Tonsillectomy for Pediatric Obstructive Sleep Apnea: Indications and Surgical Technique","authors":"Mattie Rosi-Schumacher MD , Habib Zalzal MD , Michele M. Carr DDS, MD, PhD","doi":"10.1016/j.otot.2023.09.008","DOIUrl":"10.1016/j.otot.2023.09.008","url":null,"abstract":"<div><p><span><span>The objective of this chapter is to describe lingual tonsillectomy<span> (LT) as a treatment strategy for children with persistent </span></span>obstructive sleep apnea<span> after adenotonsillectomy. Drug-induced sleep </span></span>endoscopy<span><span><span><span> is a useful tool that enables physicians to identify sites of obstruction resulting from dynamic airway collapse and direct surgical interventions accordingly. </span>Lingual tonsil hypertrophy is graded according to the degree of effacement of the vallecula and the posterior displacement of the </span>epiglottis<span>. The surgical technique for microscopic- and endoscopic-assisted coblation LT is described along with postoperative care and complications. LT is an important and efficacious technique for the treatment of pediatric obstructive sleep apnea </span></span>in patients<span> with base of tongue obstruction.</span></span></p></div>","PeriodicalId":39814,"journal":{"name":"Operative Techniques in Otolaryngology - Head and Neck Surgery","volume":"34 3","pages":"Pages 179-184"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135347433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Nasal surgery for pediatric obstructive sleep apnea","authors":"Habib G. Zalzal MD","doi":"10.1016/j.otot.2023.09.005","DOIUrl":"10.1016/j.otot.2023.09.005","url":null,"abstract":"<div><p>Nasal obstruction is one of the more common complaints seen in children, which can exacerbate symptoms of sleep disordered breathing<span>. Sites of obstruction within the nasal passage are due to inferior turbinate hypertrophy and septal deviation. The inferior nasal turbinates, due to internal nasal valve positioning, can be surgically addressed following a trial of medication. This article will focus on the 2 most frequently utilized surgical techniques today for inferior turbinate reduction in children: microdebridement and coblation technology.</span></p></div>","PeriodicalId":39814,"journal":{"name":"Operative Techniques in Otolaryngology - Head and Neck Surgery","volume":"34 3","pages":"Pages 165-169"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135297757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Richmond Quan Qing Lim MMed ORL , Jian Li Tan FAMS (ORL) , Jin Keat Siow FAMS (ORL)
{"title":"Endoscopic marsupialization of nasolabial cysts with added mucosal flap spacer prevents recurrence","authors":"Richmond Quan Qing Lim MMed ORL , Jian Li Tan FAMS (ORL) , Jin Keat Siow FAMS (ORL)","doi":"10.1016/j.otot.2023.09.013","DOIUrl":"10.1016/j.otot.2023.09.013","url":null,"abstract":"<div><p>Management of a nasolabial cyst typically involves surgical excision via a sublabial approach but the thin plane of dissection may lead to a cyst rupture<span><span><span>, or a breach of the nasal mucosa. Endoscopic endonasal </span>marsupialization<span> has been recently described, but there is a risk of fistula stenosis and cyst recurrence especially for small nasolabial cysts with small intranasal components. We describe a modification of the endoscopic endonasal marsupialization technique by incorporating an inferiorly based flap that acts as a spacer to prevent recurrence. The procedure is performed under </span></span>general anesthesia<span>. With endoscopic guidance, the intranasal cyst wall is incised from a posterior superior to anterior inferior direction. The medial cyst wall is left pedicled inferiorly, trimmed to size and is rolled into the cyst cavity to act as a spacer. This technique has been performed in 4 patients with cyst sizes ranging from 9 to 29 mm with no recurrences at least 6 months postoperatively. Previous reports have described recurrence at 6 months after endoscopic marsupialization, despite an intranasal cyst opening of 10 × 10 mm. This simple modification of the previously described endoscopic marsupialization technique has successfully prevented stenosis and recurrence even in patients with small nasolabial cysts.</span></span></p></div>","PeriodicalId":39814,"journal":{"name":"Operative Techniques in Otolaryngology - Head and Neck Surgery","volume":"34 3","pages":"Pages e23-e26"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135484430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Combined pectoralis major and deltopectoral flap for reconstruction in head and neck cancer: Revisiting the historic flap","authors":"Shivang Shukla MBBS, MS, Shivam Pandya MBBS, MS, MCH, Satyadeep Bikkina MBBS, MS, Priyank V Rathod MBBS, MS, MCH, Shashank Pandya MBBS, MS, MCH, Mohit Sharma MBBS, MS, MCH, Shailesh Patel MBBS, MS, MCH, Vikas Warikoo MBBS, MS, MCH, Abhijeet Salunke MBBS, MS, Ketul Puj MBBS, MS, MCH","doi":"10.1016/j.otot.2023.02.002","DOIUrl":"10.1016/j.otot.2023.02.002","url":null,"abstract":"<div><p><span>Deltopectoral flap was discovered in early 90s and used for nasal and pharyngeal reconstructions, since then its use has diminished over the years. We have tried to use this historic flap with the robust pectoralis major flap to reconstruct large head and </span>neck defects<span>. Though the ideal flap for such defects would be a free flap, in developing nations due to resource intense settings free flap is not always feasible. Our aim is to review combined deltopectoral and pectoralis major flap for large head and neck reconstructions. A retrospective study of 30 patients was done in our institute. Patients included in the study were resectable head and neck cancers with extensive skin involvement. A combined deltopectoral and pectoralis major flap was used to reconstruct the defect. A combined use of deltopectoral and pectoralis major flaps can be an effective alternative to free flaps in developing nations due to lack of resources and large volume of cases.</span></p></div>","PeriodicalId":39814,"journal":{"name":"Operative Techniques in Otolaryngology - Head and Neck Surgery","volume":"34 3","pages":"Pages e36-e41"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44123987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Francesca C. Viola MD , Jyoti M. Sharma MD , Chloe C. Cottone BA , Michele Carr DDS, MD, PhD, FRCSC
{"title":"Supraglottoplasty in children with obstructive sleep apnea","authors":"Francesca C. Viola MD , Jyoti M. Sharma MD , Chloe C. Cottone BA , Michele Carr DDS, MD, PhD, FRCSC","doi":"10.1016/j.otot.2023.09.010","DOIUrl":"10.1016/j.otot.2023.09.010","url":null,"abstract":"<div><p><span><span>Supraglottoplasty involves the reshaping or removal of obstructive tissue from the upper larynx. This procedure is commonly done for patients with </span>laryngomalacia<span><span><span> when the airway obstruction from laryngeal collapse is significant enough to cause obstructive sleep apnea (OSA). Supraglottoplasty may involve the </span>epiglottis, the </span>aryepiglottic folds and the postglottis. Supraglottoplasty can be done using cold steel, CO</span></span><sub>2</sub><span> laser, or coblation. Supraglottoplasty is considered an effective treatment for OSA in some children. The procedure has a high success rate, few complications, and often results in reduction of sleep and breathing symptoms. This article will discuss the indications, technique, and complications of supraglottoplasty.</span></p></div>","PeriodicalId":39814,"journal":{"name":"Operative Techniques in Otolaryngology - Head and Neck Surgery","volume":"34 3","pages":"Pages 190-194"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135349535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maya Raghavan MSPH , Annie Farrell MD, MSc , Michael Cipolla MD , Michele M. Carr DDS, MD, PhD, FRCSC , Clarice Brown MD
{"title":"Review of intracapsular vs extracapsular tonsillectomy","authors":"Maya Raghavan MSPH , Annie Farrell MD, MSc , Michael Cipolla MD , Michele M. Carr DDS, MD, PhD, FRCSC , Clarice Brown MD","doi":"10.1016/j.otot.2023.09.006","DOIUrl":"10.1016/j.otot.2023.09.006","url":null,"abstract":"<div><p>Tonsillectomy<span> is a common surgical procedure performed in children for recurrent tonsillitis<span> and obstructive sleep apnea. Though tonsillectomy is a longstanding and well-known procedure, preferred techniques for delivering the most effective and safe care still vary amongst surgeons. In this review, we provide a comparison of intracapsular versus extracapsular tonsillectomy techniques and potential benefits of each.</span></span></p></div>","PeriodicalId":39814,"journal":{"name":"Operative Techniques in Otolaryngology - Head and Neck Surgery","volume":"34 3","pages":"Pages 170-173"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135205365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mattie Rosi-Schumacher MD , Sam Colca BS , Amanda B. Hassinger MD, MSc
{"title":"Diagnosis of pediatric obstructive sleep apnea for otolaryngologists","authors":"Mattie Rosi-Schumacher MD , Sam Colca BS , Amanda B. Hassinger MD, MSc","doi":"10.1016/j.otot.2023.09.003","DOIUrl":"10.1016/j.otot.2023.09.003","url":null,"abstract":"<div><p><span><span>This review describes the current state of the evaluation and diagnosis of pediatric </span>sleep apnea. Sleep apnea in children differs in important ways from sleep apnea in adults and commonly presents with more subtle symptoms. While there can be snoring, noisy breathing, and </span>sleepiness<span>, not all children with sleep apnea snore. Early symptoms can be speech delay, nap refusal, nocturnal enuresis<span><span>, headaches, and hyperactivity. Children with sleep apnea may have tonsil and/or </span>adenoid hypertrophy<span><span><span>, adenoid facies, mouth-breathing, hyponasality, or low-hanging </span>soft palate on exam. While many screening tools exist, definitive diagnosis of sleep apnea in children requires </span>polysomnography<span>. Nocturnal oximetry and home studies are not conclusive but can serve as a screening tool where pediatric polysomnography is not available. In conclusion, pediatric obstructive sleep apnea presents differently than adults and can only be definitively diagnosed with an in-lab polysomnography.</span></span></span></span></p></div>","PeriodicalId":39814,"journal":{"name":"Operative Techniques in Otolaryngology - Head and Neck Surgery","volume":"34 3","pages":"Pages 152-158"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135249307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ariel Omiunu MD , Marta Kulich MD , Alison Ma MS , Mohamed Elrakhawy MD , Michele Carr DDS, MD, PhD
{"title":"Drug-induced sleep endoscopy in children","authors":"Ariel Omiunu MD , Marta Kulich MD , Alison Ma MS , Mohamed Elrakhawy MD , Michele Carr DDS, MD, PhD","doi":"10.1016/j.otot.2023.09.004","DOIUrl":"10.1016/j.otot.2023.09.004","url":null,"abstract":"<div><p>Drug-induced sleep endoscopy<span> (DISE) has become an essential diagnostic tool in children with persistent obstructive sleep apnea<span> (OSA) after adenotonsillectomy<span> or those at high risk of persistent OSA. Utilizing either propofol<span><span> or dexmedetomidine </span>intravenous sedation to model sleep in the operating room, a flexible laryngoscope is used to look for obstruction at each level of the airway. Several pediatric-specific DISE scoring systems have been published in an effort to provide a thorough and reproducible airway assessment. Although they all assign severity grades, the scoring systems differ depending on which anatomic subsites they include. DISE-directed surgery encompasses a set of procedures which target areas of airway obstruction identified during sleep endoscopy.</span></span></span></span></p></div>","PeriodicalId":39814,"journal":{"name":"Operative Techniques in Otolaryngology - Head and Neck Surgery","volume":"34 3","pages":"Pages 159-164"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135255369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aaron Snow MD , Mikayla J. Huestis MD , Cristina M. Baldassari MD
{"title":"Surgical treatment of palatal collapse in pediatric obstructive sleep apnea","authors":"Aaron Snow MD , Mikayla J. Huestis MD , Cristina M. Baldassari MD","doi":"10.1016/j.otot.2023.09.007","DOIUrl":"10.1016/j.otot.2023.09.007","url":null,"abstract":"<div><p><span><span><span><span>Pediatric </span>obstructive sleep apnea (OSA) is characterized by upper airway collapse that results in poor, restless sleep, and daytime </span>sequelae such as </span>sleepiness<span><span> and behavior problems. The primary treatment for pediatric OSA has traditionally been </span>adenotonsillectomy (AT). However, rates of persistent OSA following AT can be as high as 50%. With the increased utilization of drug-induced sleep </span></span>endoscopy<span><span> in both surgically-naïve pediatric OSA patients and patients with persistent OSA after AT, the palate has been identified as a common site of collapse contributing to airway obstruction. Palatal procedures, such as palatopharyngopexy and </span>barbed suture<span> pharyngoplasty, can be utilized to address collapse at the palate and may improve pediatric OSA treatment outcomes.</span></span></p></div>","PeriodicalId":39814,"journal":{"name":"Operative Techniques in Otolaryngology - Head and Neck Surgery","volume":"34 3","pages":"Pages 174-178"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135297802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The history of pediatric sleep surgery","authors":"Raihanah Alsayegh MD , Nicole Molin MD , Michele M. Carr MD, DDS, PhD","doi":"10.1016/j.otot.2023.09.001","DOIUrl":"10.1016/j.otot.2023.09.001","url":null,"abstract":"<div><p>Although pediatric sleep disorders<span><span>, including obstructive sleep apnea, are increasingly recognized, this was not the case until recent years. This review takes the reader on a journey from the recognition of obstructive sleep apnea as a disorder that commonly affects children through the subsequent evolution of </span>pediatric sleep surgery.</span></p></div>","PeriodicalId":39814,"journal":{"name":"Operative Techniques in Otolaryngology - Head and Neck Surgery","volume":"34 3","pages":"Pages 142-146"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135347088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}