Midline posterior glossectomy and lingual tonsillectomy in children with refractory obstructive sleep apnoea: factors that influence outcomes

Background: Tongue base reduction (TBR) can be performed by lingual tonsillectomy (LT) or midline posterior glossectomy (MPG) or a combination of these procedures. MPG is less commonly performed and there is a paucity of data regarding the outcomes of this procedure. The aim of this study was to identify factors that influence surgical outcomes in TBR for the treatment of paediatric refractory obstructive sleep apnoea (rOSA). Methods: A retrospective analysis of all consecutive TBR cases from 1^st January 2007 to 30^th June 2021 was conducted at Perth Children's Hospital in Western Australia. Fifteen patients (73.3% male; age, 10 months-15 years) met the inclusion criteria: children under 16 years of age who underwent MPG and/or LT for rOSA after failing adenotonsillectomy (AT) and/or positive airway pressure (PAP) therapy. Results: Thirteen patients had moderate to severe OSA prior to TBR. Eleven patients had a recognised syndrome. One-third of the patients were obese [body mass index (BMI) ≥95^th percentile]. Most patients (12/15) in this study had MPG. Ten patients (66.7%) demonstrated complete resolution of rOSA after TBR. Mean obstructive apnoea hypopnoea index (OAHI) reduced by 11.75 [standard deviation (SD), 28.8; range, −56.1 to 57.3]. Children with healthy weight had the greatest improvements in OAHI (P=0.0682). Gender and the presence of a syndromic diagnosis did not affect changes in OAHI. Conclusions: TBR appears to be a safe and effective treatment option for paediatric rOSA. A healthy BMI was associated with a positive outcome. We recommend a multidisciplinary approach to preoperative weight loss and medical optimization to maximise the benefit of TBR.