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수면호흡장애 소아에서 편도 및 아데노이드 절제술과 비갑개 후방축소술 동반 시행 시 효용성에 대한 고찰

The Efficacy of Posterior Turbinoplasty in Combination with Tonsillectomy and Adenoidectomy in Pediatric Sleep Disordered Breathing Patients

대한이비인후과학회지-두경부외과학 2020년 63권 5호 p.216 ~ 222
배재훈 ( Bae Jae-Hoon ) - Kwangju Hospital of Christian Department of Otolayngology-Head and Neck Surgery

이장수 ( Lee Jang-Su ) - Kwangju Hospital of Christian Department of Otolayngology-Head and Neck Surgery
김남국 ( Kim Nam-Guk ) - Kwangju Hospital of Christian Department of Otolayngology-Head and Neck Surgery

Abstract


Background and Objectives: Tonsillectomy and adenoidectomy (T&A) are effective for the treatment of pediatric sleep disorder breathing. However, in some pediatric patients, there remain unresolved snoring and mouth breathing problems after the operation. This study is aimed at evaluating the efficacy of coblation of hypertrophic posterior turbinate in combination with tonsillectomy and adenoidectomy.

Subjects and Method: We analyzed data from 50 children aged between 5 to 13 years old who were scheduled to undergo T&A operation from June 2018 to December in 2018. We randomly divided them into two groups. The first group consisted of 25 patients who were scheduled to perform only tonsillectomy and adenoidectomy. The second group was 21 patients who were scheduled to perform posterior turbinoplasty in combination with tonsillectomy and adenoidectomy. We evaluated preoperative and postoperative polysomnogram [Apnea-Hypopnea Index (AHI), O2 saturation], acoustic rhinometry (minimal cross section area, nasal volume), and Korean Obstructive Sleep Apnea-18 Survey (KOSA-18) score.

Results: After additional turbinoplasty (coblation of hypertrophic posterior turbinate), the rate of snoring and mouth breathing remaining was decreased. There were significant improvements in AHI, oxygen saturation, Visual Analog Scale and Epworth Sleepiness Scale in two groups. Symptoms (snoring and mouth breath) remaining postoperatively was much more decreased in the posterior turbinoplasty combined with T&A group than in the single T&A group in terms of KOSA-18.

Conclusion: When it comes to pediatric sleep disorder breathing surgery, nasal cavity evaluation is an important factor for patient’s postoperative satisfaction for sleeping and snoring. For pediatric sleep disorder breathing patients with hypertrophic posterior turbinate, who are scheduled to do tonsillectomy and adenoidectomy, an additional coblation of posterior turbinate should be considered.

키워드

Posterior turbinate hypertrophy; Sleep disordered breathing; Tonsillectomy
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