抄録
Adenoid and tonsillar hypertrophy is the most important cause of obstructive sleep apnea syndrome (OSAS) in children. A majority of these patients are successfully treated with adenotonsillectomy. However, it is difficult to treat those who have no adenotonsillar hypertrophy.
We studied 5 children with severe OSAS who showed no signs of adenotonsillar hypertrophy. All of them had other congenital malformations and associated systemic disorders. They were tested with inductive plethysmography and pulse oximetry. Apnea had been present since birth and had become worse recently. In relation to upper airway obstruction, micrognathia was noted in 4 patients, anterior dislocation of the atlas in 2 and cerebral palsy in 2. In children with cerebral palsy general muscular hypotonia plays a significant role in their obstruction.
Cephalometric analysis showed no signs of adenotonsillar hypertrophy. Poor prognathism of the maxilla and mandible and low positioned hyoid bones were thought to contribute to upper airway obstruction.
We performed tracheostomy in 2 patients. Uvulopalatopharyngoplasty (UPPP) was effective in the 1 patient. A nasopharyngeal tube was useful for treatment and for locating the site of the obstruction. If no adenotonsillar hypertrophy was apparent, UPPP with or without adenotonsillectomy improved OSAS in selected children. Because UPPP can enlarge the diameter of the nasopharyngeal airspace.
