Utility of Pharyngoplasty in Obese Pediatric Patients

Introduction: Suturing the soft tissues of the pharynx at the time of adenotonsillectomy (AT) may lead to a greater reduction in postoperative apnea/hypopnea events in children with obstructive sleep apnea (OSA). Studies have examined various pharyngoplasty techniques, yet none have examined a large pediatric OSA population with a high prevalence of obesity undergoing concurrent AT and pharyngoplasty.

Methods: Given the lack of dedicated Current Procedural Terminology (CPT) code for pharyngoplasty, cases were identified by individual surgeon records over 2 years. Retrospective chart review was conducted to obtain demographic, polysomnogram (PSG), and clinical outcomes data.

Results: In total, 68 children who underwent AT with concurrent pharyngoplasty and/or pillarplasty were included. Mean age was 10.5 years (range 1 - 18). Of the children, 4 had Down syndrome, and 1 had Noonan syndrome. Additionally, 57 children (83.8%) were obese, with BMI for age >95th percentile. Mean and median preoperative AHI were 29.6 and 20.7, respectively (range: 2.6 – 157). Mean and median obstructive AHI were 25.4 and 16.4 (range: 2.2 – 156.8). Mean and median REM oxygen nadir were 83.4% and 86%. Half of the children (34) had a postoperative PSG, with a mean time of 5 months from surgery. The postoperative mean and median AHI were 9.15 and 7.9, respectively (range: 0.6-40.6). Mean change in AHI postoperatively was 29.2 (range: 1.9-116.2), and mean percent change in AHI was 72%. Postoperative mean and median obstructive AHI were 7.9 and 6.1, respectively (range: 0.6 – 40.6). Mean and median REM oxygen nadir were 87.4% and 89%. One child experienced postoperative bleeding requiring return to OR.

Conclusions: AT with concurrent pharyngoplasty is a safe and effective alternative to AT alone for children with obesity, who are at high risk for refractory obstructive sleep apnea. Further comparative analyses with age-matched and severity-matched controls are in process.