Palatal Surgery: Expanding Options for Pediatric Sleep Apnea Treatment

PROGRAM DESCRIPTION: Obstructive sleep apnea (OSA) occurs in approximately 3-4% of children within the U.S with adenotonsillectomy (T&A) being the first-line surgical treatment option. With T&A, rates of OSA resolution range from 15-85% in healthy children. In children with comorbidities involving dynamic muscular hypotonia or static airway narrowing such as Down’s syndrome, cerebral palsy, or obesity, persistent OSA following T&A (AHI ≥1 or ≥5) can occur in up to 85% of children. Treatment options for persistent OSA in children are limited with poor compliance in many children treated with positive airway pressure therapy.

Since the introduction of the UPPP approximately 50 years ago, palatal surgery has been shown to be safe and effective in the treatment of adult OSA with an average AHI reduction approaching 20-25 events/hour. Increasing utilization of drug induced sleep endoscopy in the evaluation of patients with OSA has led to the identification of different patterns of palatal collapse contributing to upper airway obstruction. Novel palatal surgery techniques beyond traditional uvulopalatopharyngoplasty including expansion sphincter pharyngoplasty, palatopharyngopexy, and barbed reposition pharyngoplasty have subsequently been developed to address palatal collapse. These palatal surgery techniques are increasingly being performed in children with OSA. This course will review indications for palatal surgery for pediatric OSA including both surgically naïve children and those with persistent OSA following T&A. We will review sleep endoscopy videos of children that would benefit from palatal surgery. Additionally, this course will concentrate on palatal surgery techniques (including procedural videos), outcomes, and complications. A case-based format will be utilized to highlight pearls and controversies in pediatric palatal surgery. After attending this lecture, otolaryngologists will understand how to incorporate palatal surgery into the management of pediatric OSA to improve treatment outcomes.

OUTCOME OBJECTIVE 1: To understand the indications for palatal surgery in the treatment of pediatric OSA, including which children would benefit from palatal surgery at the time of adenotonsillectomy.

OUTCOME OBJECTIVE 2: To compare different palatal surgery techniques that can be used to treat OSA in children and describe the pediatric-specific nuances frequently encountered.

OUTCOME OBJECTIVE 3: To review postoperative management, outcomes, expectations, and complications after palatal surgery in children for treatment of OSA.

BACKGROUND STATEMENT: Adenotonsillectomy frequently fails to resolve OSA in syndromic children or those with comorbidities such as obesity. This topic will review the pediatric indications, candidacy, techniques, and outcomes of palatal surgery for the treatment of OSA in children.

Comprehensive Otolaryngology Track Statement :