Epiglottopexy has acquired a new indication, and sleep endoscopy is why

Design

PRISMA-ScR scoping review, protocol registered, two independent reviewers

Population

24 studies, 371 children under 18 undergoing epiglottopexy, published 1987 to 2026 across 10 countries

Primary outcome

indications, techniques, outcomes and complications of paediatric epiglottopexy

Effect

consistent respiratory improvement, swallowing largely preserved or improved, low complication and recurrence rates, single-procedure success in most cases

A PRISMA-ScR scoping review searched from 1980 to May 2026 and found 24 studies covering 371 children who underwent epiglottopexy, from 10 countries — case reports, case series and retrospective cohorts, with no controlled trials.

The techniques vary: endoscopic CO₂ laser or cautery-assisted glossoepiglottopexy, transoral suture-based epiglottopexy, transcervical external fixation, and robot-assisted approaches. The indications have widened. Alongside classic Type III laryngomalacia and epiglottic prolapse complicating tracheostomy-dependent or syndromic airway disease, the review documents a growing group: children with refractory obstructive sleep apnoea in whom drug-induced sleep endoscopy shows epiglottic obstruction. Across the literature, respiratory improvement was consistent, swallowing was largely preserved or improved, and complications and recurrence were low with single-procedure success in most cases.

The evidence base is the problem, and the authors say so — small retrospective series, no standardised outcome measures, short follow-up. What the review supports is that epiglottic obstruction on sleep endoscopy is worth looking for in a child whose apnoea persists after adenotonsillectomy, because there is now a procedure that addresses it.

• Consider drug-induced sleep endoscopy in children with obstructive sleep apnoea persisting after adenotonsillectomy
• Look specifically for sleep-state-dependent epiglottic collapse, which wakeful endoscopy will miss
• Discuss epiglottopexy as an option with honest framing — the evidence is case series, not trials
• Assess and document swallowing before and after; preservation is reported but not measured consistently
• Record outcomes prospectively if you do these — the literature needs it

Why it matters

It names a cause of persistent paediatric apnoea that standard assessment does not detect.

Don't overread it

A scoping review of 24 uncontrolled studies — safety and efficacy are 'consistently reported', not demonstrated against a comparator.

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