Surgical management of sleep-disordered breathing in children

Pediatric obstructive sleep apnea is a multifactorial condition, with anatomical and neuromuscular components, significantly affecting the child׳s quality of life and long-term health outcomes. Workup may include polysomnography, endoscopy, and imaging to identify primary sites of obstruction. Adenotonsillectomy remains one of the first-line surgical options, with multiple modalities described. Palate and pharyngeal surgeries include lateral pharyngoplasty, modified expansion pharyngoplasty, and uvulopalatopharyngoplasty. Lingual tonsillectomy, midline posterior glossectomy, and tongue base suspension have been used to relieve the tongue base component of obstructive sleep apnea. Laryngomalacia, whether congenital or occult in the older pediatric patient, may cause obstruction and necessitate supraglottoplasty with or without epiglottopexy. Patients with syndromes, those with craniofacial abnormalities, and those with concomitant neurologic conditions often require multiple and more complex surgical interventions. Tracheostomy definitively relieves upper airway obstruction.