Treatment methods of obstructive sleep apnea (OSA) in children with adenoid hypertrophy and contraindications for adenectomy

Abstract

Obstructive sleep apnea (OSA) is a common problem in pediatric population, most frequently caused by the adenoid hypertrophy. Improper sleep pattern leads to an inadequate night rest and therefore influences daytime behavior. The easiest method of treatment in such cases is adenectomy, which means the excision of the adenoid (so called „third tonsil”). Obviously, it should be performed only after an objective confirmation of the etiology in the fiberoscopy. Children with defects in the palatine, like „overt” and „occult” submucous cleft palate, cleft palate or after palatine reconstructions, stand for an exceptional group of patients. On one hand, all the reconstructive surgeries increase the risk of an obstructive sleep apnea in such children, while on the other hand palatal defects are a classic contraindication for adenectomy. Adenectomy is contraindicated due to an increased risk of velopharyngeal insufficiency, which impairs the act of swallowing and speech. When aggravated symptoms are observed, after specialist phoniatrics consultation, a partial adenectomy should be considered. This procedure means partial excision of the adenoid, where only the superior part of the adenoid, responsible for the blockage of the airflow through posterior choanae, is excised, and at the same time the inferior part is left, providing contact between the adenoid and the soft palate (what is responsible for the preservation of veloadenoidal closure).