Effect of cleft palate repair with vomer flap on incidence and severity of obstructive sleep apnea

2021 ◽  
Author(s):  
Gokhan Sert ◽  
Mert Calis ◽  
Ahmet Emre Suslu ◽  
Figen Ozgur
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cleft Palate ◽  
Obstructive Sleep ◽  
Cleft Palate Repair ◽  
Palate Repair ◽  
Vomer Flap

Robin Sequence: Obstructive Sleep Apnea following Pharyngeal Flap

1997 ◽  
Vol 34 (3) ◽  
pp. 256-260 ◽  
Author(s):  
David L. Abramson ◽  
Eileen M. Marrinan ◽  
John B. Mulliken
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Robin Sequence ◽  
Obstructive Sleep ◽  
High Incidence ◽  
Cleft Palate Repair ◽  
Palate Repair ◽  
Pharyngeal Flap ◽  
Velopharyngeal Function ◽  
Repair Group

Objective We reviewed 24 children with Robin sequence who underwent cleft palate repair. Method All patients were 5 years of age or older at the time of review, allowing for accurate assessment of speech in relation to velopharyngeal function. All infants had palatal closure between 9 and 14 months of age, either V-Y repair (n = 16) or von Langenbeck repair (n = 8). Results Only 1 of 16 children who had V-Y repair had borderline velopharyngeal dysfunction (VPD). For reasons that are unclear, in the von Langenbeck repair group, six of eight children had VPD, and four of six underwent pharyngeal flap. Three additional patients with nonsyndromic Robin sequence had palatoplasty and subsequent pharyngeal flap. Six of the combined total of seven children with nonsyndromic Robin sequence developed obstructive sleep apnea and required flap take-down. Conclusion Since conventional pharyngeal flap for VPD in nonsyndromic Robin sequence children resulted in a high incidence of obstructive sleep apnea, alternative management should be considered: modification of the standard pharyngeal flap, palatal lengthening (V-Y or double-opposing Z-plasty), or construction of a speech bulb.

scholarly journals Speech Outcomes after Tonsillectomy in Patients with Known Velopharyngeal Insufficiency

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
L. M. Paulson ◽  
C. J. MacArthur ◽  
K. B. Beaulieu ◽  
J. H. Brockman ◽  
H. A. Milczuk
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cleft Palate ◽  
Speech Intelligibility ◽  
Velopharyngeal Insufficiency ◽  
Speech Evaluation ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
Before And After ◽  
History Of

Introduction. Controversy exists over whether tonsillectomy will affect speech in patients with known velopharyngeal insufficiency (VPI), particularly in those with cleft palate.Methods. All patients seen at the OHSU Doernbecher Children's Hospital VPI clinic between 1997 and 2010 with VPI who underwent tonsillectomy were reviewed. Speech parameters were assessed before and after tonsillectomy. Wilcoxon rank-sum testing was used to evaluate for significance.Results. A total of 46 patients with VPI underwent tonsillectomy during this period. Twenty-three had pre- and postoperative speech evaluation sufficient for analysis. The majority (87%) had a history of cleft palate. Indications for tonsillectomy included obstructive sleep apnea in 11 (48%) and staged tonsillectomy prior to pharyngoplasty in 10 (43%). There was no significant difference between pre- and postoperative speech intelligibility or velopharyngeal competency in this population.Conclusion. In this study, tonsillectomy in patients with VPI did not significantly alter speech intelligibility or velopharyngeal competence.

Incidence and Severity of Obstructive Sleep Apnea following Pharyngeal Flap Surgery in Patients with Cleft Palate

2002 ◽  
Vol 39 (3) ◽  
pp. 312-316 ◽  
Author(s):  
Yu-Fang Liao ◽  
Ming-Lung Chuang ◽  
Philip K.T. Chen ◽  
Ning-Hung Chen ◽  
Claudia Yun ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cleft Palate ◽  
Flap Surgery ◽  
Adult Group ◽  
Child Group ◽  
Obstructive Sleep ◽  
Pharyngeal Flap ◽  
Respiratory Disturbance ◽  
Different Levels

Objective: To investigate the incidence and severity of obstructive sleep apnea (OSA) associated with pharyngeal flap surgery in patients with cleft palate at least 6 months postoperatively and to determine whether age or the flap width had an effect on them. The hypothesis tested in this study was that the severity of OSA associated with pharyngeal flap surgery is greater in children than in adults. Subjects: Ten adults, six men and four women, with a mean age of 28.0 years at pharyngeal flap (adult group). Twenty-eight children, 13 boys and 15 girls, with a mean age of 6.3 years at pharyngeal flap (child group). Design: A prospective analysis. Main Outcome Measures: An overnight polysomnographic study was used to determine the incidence and severity of OSA 6 months after pharyngeal flap. Results: The incidence of OSA following pharyngeal flap was high but not significantly different between these two groups (90% in adults and 93% in children, p = 1.000). When OSA was stratified into different levels of severity according to the values of respiratory disturbance index, there were noticeable differences between these two groups (p = .022). In the adult group, eight patients (89%) had mild OSA and 1 patient (11%) had moderate to severe OSA. In the child group, 11 patients (42%) were found to have mild OSA, and 15 patients (58%) had moderate to severe OSA. No relation was found between the flap width and the incidence (p = .435 in adults and .640 in children) or the severity (p = .325 in adults and .310 in children) of OSA in each group. Conclusions: Six months following pharyngeal flap surgery, more than 90% of the patients with cleft palate still had OSA. The severity of OSA associated with pharyngeal flap surgery tended to be greater in children than in adults. The flap width was unrelated to the incidence and severity of OSA, no matter in adults or in children.

Comparison of Obstructive Sleep Apnea Syndrome in Children with Cleft Palate following Furlow Palatoplasty or Pharyngeal Flap for Velopharyngeal Insufficiency

2004 ◽  
Vol 41 (2) ◽  
pp. 152-156 ◽  
Author(s):  
Yu-Fang Liao ◽  
M. Samuel Noordhoff ◽  
Chiung-Shing Huang ◽  
Philip K. T. Chen ◽  
Ning-Hung Chen ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cleft Palate ◽  
Obstructive Sleep Apnea Syndrome ◽  
Sleep Apnea Syndrome ◽  
Velopharyngeal Insufficiency ◽  
Obstructive Sleep ◽  
The Mean ◽  
Pharyngeal Flap ◽  
Apnea Syndrome

Objective To evaluate the incidence and severity of obstructive sleep apnea syndrome (OSAS) in patients with cleft palate having a Furlow palatoplasty or pharyngeal flap for correction of velopharyngeal insufficiency (VPI). Patients A total of 48 nonsyndromic children with repaired cleft palate with VPI were enrolled in the study. Twenty of the children had a Furlow palatoplasty (F group) and 28 children had a pharyngeal flap (P group) for correction of VPI. Interventions An overnight polysomnography evaluation was done to evaluate the incidence and severity of OSAS 6 months or more postoperatively. Main Outcome Measures Symptoms of OSAS, respiratory disturbance index (RDI), oxyhemoglobin desaturation index (DI), and sleep stages were measured. Results In the P group, the mean percentage of stage 2 sleep was lower than the F group (p < .05). The mean RDI and DI were larger in the P group, compared with the F group (p < .001). The incidence and severity of OSAS were higher in the P group, compared with the F group (p < .001 and p = 0.05, respectively). Conclusions A Furlow palatoplasty should be used in deference to a pharyngeal flap whenever possible on the basis of the preoperative evaluation of VPI because of the decreased incidence and severity of OSAS.

Surgical Closure of the Cleft Palate Has a Transient Obstructive Effect on the Upper Airway in Children

2017 ◽  
Vol 55 (1) ◽  
pp. 112-118
Author(s):  
Priscila Capelato Prado ◽  
Marilyse de Bragança Lopes Fernandes ◽  
Armando dos Santos Trettene ◽  
Alícia Graziela Noronha Silva Salgueiro ◽  
Ivy Kiemle Trindade-Suedam ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Cleft Palate ◽  
Respiratory Symptoms ◽  
Cleft Lip ◽  
Upper Airway ◽  
Surgical Closure ◽  
Obstructive Sleep ◽  
High Prevalence ◽  
Before And After ◽  
Palate Repair

Objective: To prospectively investigate the occurrence of respiratory symptoms related to obstructive sleep apnea (OSA) following primary palatoplasty in children with cleft palate (CP). Method: Fifty-six nonsyndromic children presenting CP with a previously repaired cleft lip (CL) or without CL were assessed before and after palate repair. Twenty nonsyndromic children with isolated CL were analyzed as controls before and after lip repair. Respiratory symptoms were investigated preoperatively, and at early and late postoperative periods. Based on the parent reports of “difficulty of breathing (D), apnea events (A) and/or snoring (S) during sleep, a validated OSA index (1.42D + 1.41A + 0.71S – 3.83) was used to predict absence of OSA, possible OSA, and presence of OSA, at the 3 periods analyzed. Results: Screening for OSA showed that the CP group exhibited an increased mean index at the early postoperative assessment, suggesting “possible OSA,” and a higher frequency of snoring at the early and late postoperative assessments, as compared to the CL group ( P < .05). Sleep apnea events were not reported. Conclusions: Surgical closure of the palate has an obstructive effect on the upper airway in the short term, causing OSA-related respiratory symptoms, mostly transient. However, the high prevalence of snoring still observed in the long term indicate that children with a palatal cleft who undergo surgical repair are at risk for OSA. The results support the conclusion that OSA is underappreciated in this population.

Incidence and Severity of Obstructive Sleep Apnea Following Pharyngeal Flap Surgery in Patients With Cleft Palate

2002 ◽  
Vol 39 (3) ◽  
pp. 312-316 ◽  
Author(s):  
Yu-Fang Liao ◽  
Ming-Lung Chuang ◽  
Philip K.T. Chen ◽  
Ning-Hung Chen ◽  
Claudia Yun ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cleft Palate ◽  
Flap Surgery ◽  
Obstructive Sleep ◽  
Pharyngeal Flap

Post-operative respiratory distress following primary cleft palate repair

2012 ◽  
Vol 127 (1) ◽  
pp. 65-66 ◽  
Author(s):  
D Smith ◽  
S E F H J Abdullah ◽  
A Moores ◽  
D M Wynne
Keyword(s):  
Respiratory Distress ◽  
Cleft Palate ◽  
Hospital Stay ◽  
Obstructive Sleep Apnoea ◽  
Cleft Lip And Palate ◽  
Sleep Apnoea ◽  
Obstructive Sleep ◽  
Nasopharyngeal Airway ◽  
Cleft Palate Repair ◽  
Palate Repair

AbstractIntroduction:Infants are obligate nasal breathers. Cleft palate closure may result in upper airway compromise. We describe children undergoing corrective palatal surgery who required unplanned airway support.Setting:Tertiary referral unit.Method:Retrospective study (2007–2009) of 157 cleft palate procedures (70 primary procedures) in 43 patients. Exclusion criteria comprised combined cleft lip and palate, secondary palate procedure, and pre-existing airway support.Results:The children's mean age was 7.5 months and their mean weight 7.72 kg. Eight children were syndromic, and eight underwent pre-operative sleep studies (five positive, three negative). Post-operatively, five developed respiratory distress and four required oxygen, both events significantly associated with pre-operative obstructive sleep apnoea (p = 0.001 and 0.015, respectively). Four desaturated within 24 hours. Five required a nasopharyngeal airway. Hospital stay (mean, 4 days) was significantly associated with obstructive sleep apnoea (p = 0.002) and nasopharyngeal airway insertion (p = 0.017).Discussion:Pre-operative obstructive sleep apnoea correlated significantly with post-operative respiratory distress, supplementary oxygen requirement, nasopharyngeal airway insertion and hospital stay. We recommend pre-operative sleep investigations for all children undergoing cleft palate repair, to enable appropriate timing of the procedure.

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