European Archives of Oto-Rhino-Laryngology

, Volume 274, Issue 8, pp 2981–2990 | Cite as

Tongue surgeries for pediatric obstructive sleep apnea: a systematic review and meta-analysis

  • Macario Camacho
  • Michael W. Noller
  • Soroush Zaghi
  • Lauren K. Reckley
  • Camilo Fernandez-Salvador
  • Erika Ho
  • Brandyn Dunn
  • Dylan Chan
Review Article



To evaluate the international literature for studies reporting outcomes for obstructive sleep apnea (OSA) in children undergoing isolated tongue surgeries.


Two authors searched from inception through November 14, 2016 in four databases including PubMed/MEDLINE.


351 studies were screened. Eleven studies (116 children) met criteria. Most children were syndromic and had craniofacial disorders, co-morbidities, or other serious medical issues. Surgeries included base-of-tongue (BOT) reduction (n = 114), tongue suspension (n = 1), and hypoglossal nerve stimulation (n = 1). The pre- and post-BOT reduction surgeries decreased apnea–hypopnea index (AHI) from a mean (M) and standard deviation (SD) of 16.9 ± 12.2/h to 8.7 ± 10.6/h (48.5% reduction) in 114 patients. Random effects modeling (109 patients) demonstrated a standardized mean difference for AHI of −0.78 (large magnitude of effect) [95% CI −1.06, −0.51], p value <0.00001. For BOT surgery in 53 non-syndromic children, the AHI decreased 59.2% from 14.0 ± 11.4 to 5.7 ± 6.7/h, while in 55 syndromic children, the AHI decreased 40.0% from 20.5 ± 19.1 to 12.3 ± 18.2/h. BOT reduction improved lowest oxygen saturation from M ± SD of 84.7 ± 7.4–87.9 ± 6.5% in 113 patients. Hypoglossal nerve stimulation and tongue-base suspension are limited to case reports.


Most children undergoing tongue surgeries in the literature were syndromic and had craniofacial disorders, co-morbidities, or other serious medical issues. Children with a body mass index <25 kg/m2 and non-syndromic children have had the most improvement in AHI. The specific type of surgery must be tailored to the patient. Patients with co-morbidities should undergo treatment in centers that are equipped to provide appropriate perioperative care.


Children Obstructive sleep apnea Tongue Systematic review Meta-analysis 


Compliance with ethical standards

Conflict of interest

The authors declare that there is no competing interest.


There was no funding for this review.

Ethical approval

The Tripler Army Medical Center Investigational Review Board provided approval for this meta-analysis.

Human rights

This article does not contain any studies with human participants performed by any of the authors.


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Copyright information

© Springer-Verlag Berlin Heidelberg (outside the USA) 2017

Authors and Affiliations

  1. 1.Division of Otolaryngology, Sleep Surgery and Sleep MedicineTripler Army Medical Center, Tripler AMCHonoluluUSA
  2. 2.School of MedicineUniformed Services University of the Health SciencesBethesdaUSA
  3. 3.Division of Sleep Surgery and Medicine, Department of Otolaryngology-Head and Neck SurgeryStanford Hospital and ClinicsStanfordUSA
  4. 4.Division of Otolaryngology and Sleep MedicineTripler Army Medical Center, Tripler AMCHonoluluUSA
  5. 5.John A. Burns School of MedicineUniversity of HawaiiHonoluluUSA
  6. 6.University of California Irvine Medical CenterOrangeUSA
  7. 7.Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck SurgeryUniversity of California San FranciscoSan FranciscoUSA

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