Tratamiento quirúrgico del síndrome de apnea obstructiva del sueño infantil: comparación entre adenoamigdalectomía extracapsular con bisturí frío y reducción mediante radiofrecuencia bipolar / Surgical treatment for childhood obstructive sleep apnoea: Cold-knife tonsillar dissection versus bipolar radiofrequency thermal ablation

Introducción y objetivos: La cirugía adenoamigdalar para el tratamiento de los niños con apnea obstructiva del sueño es efectiva. La incomodidad y posibles complicaciones del postoperatorio han promovido la utilización de técnicas parciales que buscan mejorar estos aspectos sin renunciar a resolver el síndrome con la misma efectividad. El objetivo es presentar la experiencia de 2 grupos consecutivos de pacientes, uno tratado con cirugía amigdalar total extracapsular y otro con reducción con radiofrecuencia bipolar mediante tunelización. Metodo: Se comparan 96 niños tratados mediante adenoamigdalectomía total extracapsular con bisturí frío y 101 tratados mediante radiofrecuencia. Se evalúa el porcentaje de casos con persistencia del síndrome (índice de apnea-hipoapnea ≥3) y la mejoría de los síntomas clínicos a un año. Se compara también el porcentaje de complicaciones quirúrgicas y anestésicas en ambos grupos. Resultado: La persistencia del síndrome fue comparable estadísticamente en ambos grupos: 25% en el grupo de bisturí frío y 22,77% en el grupo de radiofrecuencia. Las complicaciones anestésicas (5% en el grupo de bisturí frío y 4,2% en el grupo de radiofrecuencia) y los porcentajes de hemorragia postoperatoria fueron muy bajos y estadísticamente comparables con ambas técnicas. Conclusión: En el tratamiento del síndrome de apnea obstructiva del sueño infantil, tanto la cirugía extracapsular con bisturí frío como la radiofrecuencia bipolar mediante tunelización son técnicas seguras y los resultados en la resolución del síndrome no muestran diferencias estadísticamente significativas (AU)

Introduction and objective: Adenotonsillectomy for treatment of childhood obstructive sleep apnoea is effective. The uncomfortable postoperative period and possible complications have significantly increased the use of partial techniques, seeking to improve these aspects while achieving the same results in resolving sleep apnoea. The aim was to present the experience with 2 consecutive groups of patients, comparing total tonsillectomy to bipolar radiofrequency ablation (RFA). Method: A group of 96 children that underwent total tonsilloadenoidectomy using cold dissection were compared to another group of 101 children that underwent RFA. In all cases, polysomnography was performed before and 1 year after surgery. The percentage of cases with persistent disease (apnea-hypopnea index ≥ 3) and the improvement of clinical symptoms at one year were evaluated. The percentages of surgical and anaesthetic complications in both groups were also compared. Result: The persistence of the syndrome was comparable in both groups: 25% in the cold dissection and 22.77% in the radiofrequency ablation group. Anaesthetic complications (5% in the group where cold dissection was used and 4.2% in the radiofrequency ablation group) and postoperative bleeding rates were very low and statistically comparable with both techniques. Conclusion: In the treatment of childhood obstructive sleep apnoea syndrome, both extracapsular surgery using cold scalpel and bipolar radiofrequency tunnelling techniques are safe. Likewise, results as to resolution of the syndrome show no statistically significant differences (AU)

Surgical treatment for childhood obstructive sleep apnoea: Cold-knife tonsillar dissection versus bipolar radiofrequency thermal ablation. / Tratamiento quirúrgico del síndrome de apnea obstructiva del sueño infantil: comparación entre adenoamigdalectomía extracapsular con bisturí frío y reducción mediante radiofrecuencia bipolar.

INTRODUCTION AND OBJECTIVE: Adenotonsillectomy for treatment of childhood obstructive sleep apnoea is effective. The uncomfortable postoperative period and possible complications have significantly increased the use of partial techniques, seeking to improve these aspects while achieving the same results in resolving sleep apnoea. The aim was to present the experience with 2 consecutive groups of patients, comparing total tonsillectomy to bipolar radiofrequency ablation (RFA). METHOD: A group of 96 children that underwent total tonsilloadenoidectomy using cold dissection were compared to another group of 101 children that underwent RFA. In all cases, polysomnography was performed before and 1 year after surgery. The percentage of cases with persistent disease (apnea-hypopnea index ≥ 3) and the improvement of clinical symptoms at one year were evaluated. The percentages of surgical and anaesthetic complications in both groups were also compared. RESULT: The persistence of the syndrome was comparable in both groups: 25% in the cold dissection and 22.77% in the radiofrequency ablation group. Anaesthetic complications (5% in the group where cold dissection was used and 4.2% in the radiofrequency ablation group) and postoperative bleeding rates were very low and statistically comparable with both techniques. CONCLUSION: In the treatment of childhood obstructive sleep apnoea syndrome, both extracapsular surgery using cold scalpel and bipolar radiofrequency tunnelling techniques are safe. Likewise, results as to resolution of the syndrome show no statistically significant differences.

Correlación entre la clínica y la polisomnografía en los trastornos respiratorios del sueño infantil / Clinical and polysomnographic correlation in sleep-related breathing disorders in children

Introducción: A pesar de que la polisomnografía supone la prueba diagnóstica por excelencia de los trastornos respiratorios del sueño en niños, existe controversia sobre su indicación en todos los casos. De entre los argumentos utilizados, tanto a favor como en contra, se encuentra la falta de correlación existente entre sus valores objetivos y la sintomatología. Objetivo: Evaluar la correlación entre los datos clínicos y el índice de apnea-hipoapnea (IAH), en nuestro entorno de trabajo. Material y método: Se compara estadísticamente la clínica preoperatoria y el IAH de 170 niños con trastorno respiratorio del sueño, sometidos a polisomnografia. También se evalúa la correlación a nivel postoperatorio, con un subgrupo de 80 niños intervenidos de adenoamigdalectomía con seguimiento polisomnográfico a un año. Resultados: A nivel preoperatorio únicamente el grado de hipertrofia amigdalar mostró correlación significativa con el IAH. A nivel postoperatorio se evidencia una correlación entre el IAH y las apneas observadas: 38,1% de los niños mejoran según los padres en el grupo con persistencia polisomnográfica y el 66,7% en el grupo con resolución de la enfermedad (p=0,023). También muestra correlación el nivel de mejora del ronquido, valorado mediante escala analógica visual. La media bajó 5 puntos en el grupo persistente y 6,1 en el grupo con resolución de la enfermedad (p=0,047). Conclusión: A pesar de las limitaciones en la correlación entre la clínica y la polisomnografia, especialmente en el preoperatorio, la prueba objetiva por excelencia sigue siendo esta. Deben hacerse esfuerzos para conseguir parámetros objetivos que aporten mayor nivel de correlación (AU)

Introduction: Although polysomnography is the gold standard test for sleep-disordered breathing in children, there is controversy about its indication in all cases. Among the arguments both for and against is the lack of correlation between objective values and the symptoms. Objective: To evaluate the correlation between clinical data and apnea-hypopnoea index (AHI) in our work environment. Material and methods: We compared the preoperative clinical symptoms and AHI statistically in 170 children with sleep-disordered breathing who underwent polysomnography. We also analysed the correlation to postoperative level, with a subgroup of 80 children who underwent adenotonsillectomy with 1 year of polysomnography follow-up. Results: Before surgery, only the degree of tonsillar hypertrophy was statistically significant correlated with AHI. At post-operative follow-up, evidence of correlation between AHI and apnoea was observed: 38.1% of children improved in the group with persistence and 66.7% in the disease resolution group (P=0.023). In addition, the correlations showed the level of improvement of snoring, as assessed by visual analogue scale. The mean was 5 points lower in the persistent group and 6.1 lower in the disease resolution group (P=0.047). Conclusion: Despite the limitations in the correlation between clinical data and polysomnography, especially in preoperative results, polysomnography remains the gold standard diagnostic tool. Efforts should be made to obtain objective parameters that provide higher levels of correlation (AU)

Clinical and polysomnographic correlation in sleep-related breathing disorders in children.

INTRODUCTION: Although polysomnography is the gold standard test for sleep-disordered breathing in children, there is controversy about its indication in all cases. Among the arguments both for and against is the lack of correlation between objective values and the symptoms. OBJECTIVE: To evaluate the correlation between clinical data and apnea-hypopnoea index (AHI) in our work environment. MATERIAL AND METHODS: We compared the preoperative clinical symptoms and AHI statistically in 170 children with sleep-disordered breathing who underwent polysomnography. We also analysed the correlation to postoperative level, with a subgroup of 80 children who underwent adenotonsillectomy with 1 year of polysomnography follow-up. RESULTS: Before surgery, only the degree of tonsillar hypertrophy was statistically significant correlated with AHI. At post-operative follow-up, evidence of correlation between AHI and apnoea was observed: 38.1% of children improved in the group with persistence and 66.7% in the disease resolution group (P=.023). In addition, the correlations showed the level of improvement of snoring, as assessed by visual analogue scale. The mean was 5 points lower in the persistent group and 6.1 lower in the disease resolution group (P=.047). CONCLUSION: Despite the limitations in the correlation between clinical data and polysomnography, especially in preoperative results, polysomnography remains the gold standard diagnostic tool. Efforts should be made to obtain objective parameters that provide higher levels of correlation.

[Clinical diagnosis and physical examination]. / Diagnóstico clínico y exploración física.

In children, medical history and meticulous examination are essential to the diagnosis and future treatment of all the alterations contributing to sleep breathing disorders. Examination of the oropharynx aids assessment of hypertrophy of the palatine tonsils, while fiberoptic endoscopy assists in the diagnosis of adenoid hypertrophy. Among radiological examinations, only cephalometry has proved to be useful in the study of the facial skeleton. Lateral radiography of the nasopharynx to study adenoid vegetations has been surpassed by fiberoptic endoscopy in terms of diagnostic performance. All examinations facilitate an etiological and topographical diagnosis of patients with sleep breathing disorders. The diagnosis of respiratory problems that affect children's dentofacial development can begin at a very early age, since early detection is essential to preventing the effects of these alterations on orofacial morphology and function. This article reviews the basic and additional dental examinations that should be conducted in children with upper airway obstruction and a medical history of sleep breathing disorders.