Safety and efficacy of lingual tonsillectomy in multilevel airway surgery for pediatric obstructive sleep apnea

Study Objectives: Prior studies have demonstrated the efficacy of lingual tonsillectomy in treating pediatric obstructive sleep apnea. The goal of this study is to describe the postoperative outcomes following lingual tonsillectomy as a part of drug -induced sleep endoscopy-directed multilevel sleep surgery. Methods: A retrospective review was performed for pediatric patients with obstructive sleep apnea who underwent lingual tonsillectomy as a part of drug -induced sleep endoscopy-directed sleep surgery. Data collected included age, sex assigned at birth, body mass index z -score, polysomnography results, past medical and surgical history, and postoperative outcomes. Results: A total of 174 patients were included in the study with a mean age of 8.29 +/- 3.49 years (range 1.89-15.62) and mean preoperative apnea-hypopnea index of 7.88 +/- 13.42 (range 1.10-123.40). Complications occurred in 26 patients (14.9%) including 14 patients (8.0%) requiring emergency department visit or readmission and 12 patients (6.9%) experiencing postoperative bleeding. Asthma (P = .033) and developmental delay (P = .016) correlated with postoperative complications. For patients with preoperative and postoperative polysomnography data (n = 145; 83.3%), there was significant improvement (P < .001) in apnea-hypopnea index with a mean postoperative apnea-hypopnea index of 4.02 +/- 7.81 (range 0.00-54.46). Surgical failure, defined as postoperative apnea-hypopnea index >= 5, was identified in 25 patients (17.2%). Surgical failure was associated with body mass index z -score > 2 (P = .025) and Trisomy 21 (P = .005). Conclusions: This study highlights the promising surgical success rate of drug -induced sleep endoscopy-directed lingual tonsillectomy in multilevel sleep surgery (82.8%) and infrequent complications including postoperative bleeding (6.9%) and readmission (2.3%).