OBJECTIVE: Prospective survey of children up to 14 years of age with OSA submitted to adenotonsillectomy. METHODS: Clinical evaluation, with questionnaires and clinical scales evaluating facial structures including tonsils and Mallampati scales and otolaryngologic evaluation; nocturnal polysomnography and repeat evaluation three to five months postsurgery. RESULTS: Of 207 successively seen children, 199 had follow-up polysomnography, and 94 had still abnormal sleep recording. Multivariate analysis indicates that Mallampati scale score 3 and 4, retro-position of mandible, enlargement of nasal inferior turbinates at +3 (subjective scale 1 to 3), and deviated septum were significantly associated with persistence of abnormal polysomnography (with high 95% CI for Mallampati scale and deviated septum). CONCLUSION: Mallampati scale scores are resultant of several facial factors involving maxilla, mandible, and oral versus oral breathing but add information on risk of partial response to adenotonsillectomy. SIGNIFICANCE: Adenotonsillectomy may not resolve obstructive sleep apnea in children.
OBJECTIVE: Prospective survey of children up to 14 years of age with OSA submitted to adenotonsillectomy. METHODS: Clinical evaluation, with questionnaires and clinical scales evaluating facial structures including tonsils and Mallampati scales and otolaryngologic evaluation; nocturnal polysomnography and repeat evaluation three to five months postsurgery. RESULTS: Of 207 successively seen children, 199 had follow-up polysomnography, and 94 had still abnormal sleep recording. Multivariate analysis indicates that Mallampati scale score 3 and 4, retro-position of mandible, enlargement of nasal inferior turbinates at +3 (subjective scale 1 to 3), and deviated septum were significantly associated with persistence of abnormal polysomnography (with high 95% CI for Mallampati scale and deviated septum). CONCLUSION: Mallampati scale scores are resultant of several facial factors involving maxilla, mandible, and oral versus oral breathing but add information on risk of partial response to adenotonsillectomy. SIGNIFICANCE: Adenotonsillectomy may not resolve obstructive sleep apnea in children.
Authors: Carole L Marcus; Richard J H Smith; Leila A Mankarious; Raanan Arens; Gordon S Mitchell; Ravindhra G Elluru; Vito Forte; Steven Goudy; Ethylin W Jabs; Alex A Kane; Eliot Katz; David Paydarfar; Kevin Pereira; Roger H Reeves; Joan T Richtsmeier; Ramon L Ruiz; Bradley T Thach; David E Tunkel; Jeffrey A Whitsett; David Wootton; Carol J Blaisdell Journal: Proc Am Thorac Soc Date: 2009-09-15