Epiglottopexy in adults – a special case

Introduction Usually, Epiglottopexy is performed in children treating laryngomalacia. We report the case of a tetraplegic adult with extreme cervical lordosis and severe obstructive sleep apnea (OSA) with automatic positive airway pressure (APAP) intolerance. An epiglottopexy prevented the patient from having a tracheotomy to treat his OSA.

Methods The patient (51 years old, male), AHI 39,7/h (polysomnography), with APAP intolerance showed an incomplete collapse of the velum and a complete attachment of the epiglottis to the back of the pharynx with the present hyperlordosis of the cervical spine in the drug induced sleep endoscopy (DISE). Flexible endoscopic evaluation of swallowing showed no aspiration and retained sensitivity. In the case of quadriplegia after cervical spine trauma, the patient was dependent on outside help except for the hours of sleep. The patient wanted to retain his final independence and avoid a tracheotomy, so an epiglottopexy was performed.

Results Postoperative polygraphic controls (PG) were able to demonstrate good therapeutic success over a period of 33 months (AHI 10.1 and 4,9/h). With progressive spasticity as well as degenerative changes of the spine in the context of the underlying disease, the patient presented symptomatically again not before 5 years postoperatively (PG with AHI 60.5/h). He is currently refusing a tracheostomy.

Conclusion Over a period of several years, the patient’s OSA could be controlled by the individual approach and a further impairment of the quality of life by tracheotomy was postponed. In addition, this case shows the importance of an ENT examination in the case of PAP intolerance.

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Artikel online veröffentlicht:
24. Mai 2022