Vol.97 No.2 contentsPRACTICA OTO-RHINO-LARYNGOLOGICA
Vol. 97 No. 2 February 2004
A Case of Down Syndrome with Obstructive Sleep Apnea
Syndrome caused by Lingual Tonsillar Hypertrophy
-Surgical Treatment of Compensatory Hypertrophied Lingual Tonsil-
Nao Makino, Hisashi Tokano, Hiroko Kouda and Ken Kitamura
(Tokyo Medical and Dental University)
We present an 11-year-old female with Down syndrome and moyamoya disease who underwent lingual tonsillectomy for obstructive sleep apnea syndrome. She had a palatine tonsillectomy and adenoidectomy at the age of 3 years and had another adenoidectomy for regrowth at the age of 9 years.
At first examination, body mass index was 25.3. Physical examinations showed micrognathia, macroglossia, regrowth of adenoid and a remarkable lingual tonsillar hypertrophy. Her glottis was not inspected with the enlarged lingual tonsil. Preoperative polygraphy demonstrated that minimum value of
SpO2 was 47％, ％SaO2≦≦90％ was 15.6％, and apnea index (AI) was 50.9 in 330 minutes of total sleep time.
Lingual tonsillectomy was performed using an argon plasma coagulator as well as bipolar style electricity solidification. She had to be calmed postoperatively because of mental retardation and moyamoya disease. So nasotracheal intubation with propofol sedation was maintained for one week after the operation. She tolerated these procedures and her daily activity improved 7 months later. However, postoperative polygraphy exhibited no improvement in ％SaO2≦90％ or AI, with improvement in minimum value of
SpO2.
Key words : Down syndrome, sleep apnea syndrome, lingual tonsil