Epiglottopexy with and without lingual tonsillectomy.

INTRODUCTION Obstructive sleep apnea (OSA) is a syndrome of upper airway obstruction during sleep with disruption of normal ventilation. Although OSA may occur at any age, it is relatively common in childhood, with a prevalence of 2% to 3% in the general pediatric population. Even though adenotonsillectomy remains the mainstay of surgical treatment for pediatric OSA, some children will have multilevel airway obstruction and may require additional procedures. A much higher OSA prevalence of 50% to 60% is found in children with Down syndrome due to their decreased upper airway tone, midface hypoplasia, and relative macroglossia. Many of these patients will also have lingual tonsil hypertrophy and airway collapse at the level of the base of tongue and epiglottis. Treatment of OSA is of particular importance in these children, because they are at higher risk for the development of cardiopulmonary sequelae compared to other children. Unfortunately, treatment of OSA in children with Down syndrome often represents a therapeutic challenge because of their multilevel airway obstruction. Recently, sleep endoscopy has allowed for a more accurate assessment of these levels of airway obstruction and development of individually tailored surgical procedures, which may represent an alternative to continuous positive airway pressure or tracheotomy. In this article, we comprehensively describe our technique of endoscopic epiglottopexy with and without lingual tonsillectomy. Although lingual tonsillectomy has been previously described in management of persistent pediatric OSA, our technique is unique because of the use of an operating microscope and suspension laryngoscopy with a Lindholm laryngoscope. This provides the surgeon with excellent exposure and also allows for bimanual surgery, which has not been described before in children.