Success of adenotonsillectomy in the treatment of children with obstructive sleep apnea and factors affecting it

Adenoidectomy and tonsillectomy are the most frequently performed surgeries in the practice of ENT physicians. The most common pathology in obstructive sleep apnea (OSA) in children is adenotonsillar hypertrophy. In most patients, symptoms and signs decrease significantly after this surgery. However, complete recovery is rare. Although systemic diseases such as obesity, craniofacial anomalies, and neurological diseases may be among the reasons for this, residual OSA is also seen very frequently in healthy children. Although there are many studies related to this in the literature, the etiopathogenesis of the disease and the causes of persistent OSA are not fully understood. Our aim is to investigate the factors that may affect the success of adenotonsillectomy in children with OSA who do not have any comorbidity, and to reveal potential factors such as the size of adenoids and tonsils, age, gender and jaw structure. In our study, the data of children diagnosed with moderate and severe OSA polysomnographically were collected and the reasons for surgical success and failure were examined according to the preoperative and postoperative apnea-hypopnea index (AHI). In our study, the success of surgery was significantly higher in the <6 years old group with tonsil grade 3 and 4 compared to those with tonsil grade 1 and 2. Patients with persistent OSA after adenotonsillectomy (postoperative AHI ≥ 5) have different cephalometric values compared to patients recovering (postop AHI <5), especially the narrower inclination angle of the lower incisors (IMPA) and a longer distance between the mandible and hyoid (MPH) revealed as a result of our study. A higher rate of persistant OSA was detected in Angle class 3 occlusion group than in group 1 and group 2. At the same time, a significant relationship was found between a high preoperative AHI score and surgical failure. No relationship was found between age, gender and surgical failure. Keywords: adenoidectomy, tonsillectomy, adenotonsillectomy, persistent obstructive sleep apnea, snoring, cephalometry, polysomnography