ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Adenotonsillectomy First Line Surgical Treatment For Obstructive Sleep Apnea In Children
Clinical Question In children with OSA, does partial tonsillectomy as compared to adenotonsillectomy provide better outcomes as measured by efficacy and reduction of symptoms?
Clinical Bottom Line Adenotonsillectomy is the treatment of choice for children with OSA, but partial tonsillectomy may reduce postoperative discomfort at the expense of the potential for tissue regrowth. Direct comparison studies are needed. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 22926176Marcus/2012Pediatric patients treated for OSA Review
Key resultsReview of literature from 1999 through 2011. Found that adenotonsillectomy is the primary treatment for OSA in children, and there is no literature available to suggest a change in recommendations. This review reported that partial tonsillectomy has a 0.5% to 16% risk of tonsil regrowth in 1 to 18 months. Partial tonsillectomy has shown some success in decreasing immediate post-operative pain. There are no level I studies comparing partial tonsillectomy to adenotonsillectomy in pediatric populations. This review does recommend that children undergoing partial tonsillectomy have careful long-term monitoring to screen for tonsillar regrowth.
#2) 19167099Eviatar/200949 children age 10-14 treated for OSA by adenotonsillectomy or partial tonsillectomy.Retrospective Comparative Study
Key resultsRetrospective study comparing children undergoing partial tonsillectomy to tonsillectomy with a 10 year follow-up. This study found that 90.0% of patients in the partial tonsillectomy group were asymptomatic after surgery compared to 75% in the control group, which yielded no significant differences. Post-operative complications showed no significant differences between groups. This study concluded that partial tonsillectomy is as effective as tonsillectomy for children suffering from OSA due to hypertrophic tonsils, but cautioned that a large prospective study is needed before drawing firm conclusions.
#3) 21181979Stewart/2011Pediatric patients treated for OSA by adenoidectomy or partial tonsillectomyReview
Key resultsReview article of studies comparing partial tonsillectomy and adenoidectomy plus tonsillectomy from 2001 to 2009. A prospective randomized study of 92 Swedish children reported no differences in post-operative health status, behavior, snoring (frequency and loudness), concentration, temper, and stamina at 1 year and 3 years post surgery. At 3 years, 4% of children undergoing partial tonsillectomy had subsequent surgery. A five year retrospective review of 159 patients found similar results between postoperative AHI scores of patients undergoing either partial tonsillectomy or adenotonsillectomy. Tonsillar regrowth following partial tonsillectomy was a concern, but no difference was found between groups in studies reviewed for this article.
Evidence Search ("Sleep Apnea, Obstructive"[Mesh]) AND "Child"[Mesh] AND "Surgery"
Comments on
The Evidence
Difficulty in answering this clinical question definitively stems from a lack of large controlled studies directly comparing adenotonsillectomy to partial tonsillectomy. Current studies are either small, retrospective or evaluate only one treatment, making direct comparisons difficult.
Applicability The results are applicable to children diagnosed with obstructive sleep apnea that require surgery for treatment.
Specialty/Discipline (Oral Surgery) (Pediatric Dentistry)
Keywords Sleep apnea, Children, Surgery, Treatment,
ID# 2359
Date of submission: 03/18/2013spacer
E-mail mdhosking@gmail.com
Author Michael Hosking, DDS
Co-author(s) Luis C. Yepes, DDS
Co-author(s) e-mail yepes@uthscsa.edu
Faculty mentor/Co-author
Faculty mentor/Co-author e-mail
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