Zalzal Habib G, Coutras Steven
Department of Otolaryngology-Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, WV, USA.
Case Rep Otolaryngol. 2018 Dec 10;2018:2614143. doi: 10.1155/2018/2614143. eCollection 2018.
To demonstrate lateral pharyngeal wall collapse and increased apnea-hypopnea index in a child posttonsillectomy.
Some children have worsening of their sleep symptoms after tonsillectomy for obstructive sleep apnea. This case report demonstrates an open airway on drug-induced sleep endoscopy (DISE) in a child with tonsillar hypertrophy followed by more pronounced airway obstruction related to lateral pharyngeal wall collapse after tonsillectomy.
A 7-year-old boy presented with obstructive sleep apnea and underwent workup with DISE. Following adenotonsillectomy and subsequent lingual tonsillectomy with epiglottopexy, the patient's sleep apnea symptoms and polysomnogram results worsened. Subsequent DISE showed a more narrowed oropharyngeal airway space as compared to his preoperative DISE.
Palatine tonsillar tissue may splint open the airway and prevent airway obstruction in a subset of pediatric patients. Further clinical studies are necessary to determine which children experience this phenomenon. Clinical examination using DISE can be useful in making clinical decisions prior to tonsillectomy.
证明扁桃体切除术后儿童的咽侧壁塌陷及呼吸暂停低通气指数增加。
一些儿童因阻塞性睡眠呼吸暂停接受扁桃体切除术后睡眠症状恶化。本病例报告展示了一名扁桃体肥大儿童在药物诱导睡眠内镜检查（DISE）时气道开放，但扁桃体切除术后出现与咽侧壁塌陷相关的更明显气道阻塞。
一名7岁男孩因阻塞性睡眠呼吸暂停接受检查并进行了DISE。在腺样体扁桃体切除术后以及随后的舌扁桃体切除加会厌固定术后，患者的睡眠呼吸暂停症状及多导睡眠图结果恶化。随后的DISE显示，与术前DISE相比，口咽气道空间更狭窄。
腭扁桃体组织可能会撑开气道，防止一部分儿科患者出现气道阻塞。需要进一步的临床研究来确定哪些儿童会出现这种现象。使用DISE进行临床检查有助于在扁桃体切除术前做出临床决策。
