Tongue base suspension in children with cerebral palsy and obstructive sleep apnea

Objective: Children with cerebral palsy (CP) are commonly affected by obstructive sleep apnea (USA). This study examines the efficacy of combined surgical techniques for USA including tongue base suspension (TBS), using perioperative polysomnograms (PSG) in pediatric patients with CP. Study design: Case series with outcome analysis. Setting: University based tertiary care children's hospital. Methods: A 7-year retrospective chart review of children with CP who underwent surgical management for OSA. Surgical procedures, postoperative complications, and perioperative PSG data were examined. Only patients with both preoperative and postoperative PSG results were included in the study. Based upon procedures performed patients fell into 2 equal groups for analysis. Results: Fourteen children were identified. Seven patients (mean age = 6.0 years) underwent combined adenotonsillectomy (T&A), uvulopalatopharyngoplasty (UPPP), and tongue base suspension (TBS). Another 7 patients (mean age = 63 years) underwent T&A and UPPP alone. Those who received TBS had a mean preoperative AHI of 272 compared to 6.8 in the group that did not have TBS. The AHI decreased by a mean of 16.5 in the TBS group and 5.0 in the non-TBS group. The mean oxygen saturation nadir improved in both the TBS (74.0-84.0) and non-TBS (64.8-84.6) groups. The arousal index also improved in the TBS (33.1-20.7) and non-TBS (11.0-5.8) groups. No surgical complications occurred. Conclusion: This study suggests that concomitant surgical approaches for USA in children with CP are effective. Moderate to severe USA in this population may safely benefit from the added technique of tongue base suspension. Published by Elsevier Ireland Ltd.