Septoplasty for Obstructive Sleep Apnea in Infants after Cleft Lip Repair

1996 ◽  
Vol 33 (6) ◽  
pp. 473-476 ◽  
Author(s):  
Gary D. Josephson ◽  
Jamie Levine ◽  
Court B. Cutting
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Nasal Septum ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Septal Deviation ◽  
Facial Growth ◽  
Deviated Nasal Septum ◽  
Obstructive Sleep ◽  
Cleft Lip Repair

A neonate with a unilateral cleft lip and palate usually presents with a deviated nasal septum due to the asymmetric bony base associated with cleft palate. Prior to repair, the facial cleft offers a wide open breathing passage despite the septal deviation. Cleft lips are traditionally repaired in neonates at about 3 months of age. These patients usually do not present with significant symptoms of nasal obstruction following repair, except in unusual cases. Severe septal deviation may cause obstructive sleep apnea. Repair of septal deformities in children is controversial due to the potential alteration of facial growth. We present two patients with documented obstructive sleep apnea that began after cleft lip repair. Conservative surgical correction of the septal deviation resulted in relief of the sleep apnea.

Treating Velopharyngeal Inadequacy Using Bilateral Buccal Flap Revision Palatoplasty

2019 ◽  
Vol 4 (5) ◽  
pp. 878-892
Author(s):  
Joseph A. Napoli ◽  
Linda D. Vallino
Keyword(s):  
Systematic Review ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
A Priori ◽  
Sufficient Evidence ◽  
Obstructive Sleep ◽  
Before And After ◽  
Buccal Flap

Purpose The 2 most commonly used operations to treat velopharyngeal inadequacy (VPI) are superiorly based pharyngeal flap and sphincter pharyngoplasty, both of which may result in hyponasal speech and airway obstruction. The purpose of this article is to (a) describe the bilateral buccal flap revision palatoplasty (BBFRP) as an alternative technique to manage VPI while minimizing these risks and (b) conduct a systematic review of the evidence of BBFRP on speech and other clinical outcomes. A report comparing the speech of a child with hypernasality before and after BBFRP is presented. Method A review of databases was conducted for studies of buccal flaps to treat VPI. Using the principles of a systematic review, the articles were read, and data were abstracted for study characteristics that were developed a priori. With respect to the case report, speech and instrumental data from a child with repaired cleft lip and palate and hypernasal speech were collected and analyzed before and after surgery. Results Eight articles were included in the analysis. The results were positive, and the evidence is in favor of BBFRP in improving velopharyngeal function, while minimizing the risk of hyponasal speech and obstructive sleep apnea. Before surgery, the child's speech was characterized by moderate hypernasality, and after surgery, it was judged to be within normal limits. Conclusion Based on clinical experience and results from the systematic review, there is sufficient evidence that the buccal flap is effective in improving resonance and minimizing obstructive sleep apnea. We recommend BBFRP as another approach in selected patients to manage VPI. Supplemental Material https://doi.org/10.23641/asha.9919352

Symptoms of Obstructive Sleep Apnea, Nasal Obstruction, and Enuresis in Children With Nonsyndromic Cleft Lip and Palate: A Prevalence Study

2018 ◽  
Vol 56 (3) ◽  
pp. 307-313 ◽  
Author(s):  
Marilyse de Bragança Lopes Fernandes ◽  
Alícia Graziela Noronha Silva Salgueiro ◽  
Eliete Janaína Bueno Bighetti ◽  
Ivy Kiemle Trindade-Suedam ◽  
Inge Elly Kiemle Trindade
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Nasal Obstruction ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Pediatric Population ◽  
Care Center ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Obstructive Sleep

Objective: To estimate the prevalence of symptoms of obstructive sleep apnea (OSA), nasal obstruction, and enuresis in children with nonsyndromic unilateral cleft lip and palate. Design: Prospective cross-sectional study. Setting: Referral care center. Participants: One hundred seventy-four children aged 6 to 12 years of both genders. Interventions: Symptoms of OSA and nasal obstruction were investigated by analysis of scores obtained by the Sleep Disturbance Scale for Children (SDSC) and Congestion Quantifier (CQ-5). Enuresis was considered as present when urinary loss was reported during sleep (at least 1 episode/month, last 3 months). To characterize the enuresis as mono- or polysymptomatic, symptoms of dysfunction of the lower urinary tract (DLUT) were investigated by the Dysfunctional Voiding Scoring System (DVSS). Statistical analysis was performed at a 5% level of significance. Results: Positive SDSC scores for OSA were observed in 60 (34%) children; positive CQ-5 scores for nasal obstruction in 45 (26%), positive DVSS scores for DLUT in 30 (17%), and enuresis was reported by 29 (17%), being categorized as primary in 66% and polysymptomatic in 72% of the children. Compared to the pediatric population, OSA, nasal obstruction, and enuresis prevalence ratios were up to 7 (95% confidence interval [CI] 5-9), 2 (95% CI 2-3), and 3 times (95% CI 2-5) higher, respectively. There was a positive/moderate correlation between symptoms of OSA and nasal obstruction ( P = .0001). No correlation was seen between symptoms of OSA and enuresis. Conclusions: Children with nonsyndromic cleft lip and palate have high prevalence of nasal obstruction and enuresis and are at risk of OSA.

Comparison of Positive Screening for Obstructive Sleep Apnea in Patients With and Without Cleft Lip and Palate

2019 ◽  
Vol 57 (3) ◽  
pp. 364-370
Author(s):  
Hande Gorucu-Coskuner ◽  
Banu Saglam-Aydinatay ◽  
Muge Aksu ◽  
Fatma Figen Ozgur ◽  
Tulin Taner
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Breast Feeding ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Bottle Feeding ◽  
Control Group ◽  
Feeding Duration ◽  
Obstructive Sleep ◽  
Cleft Lip Palate

Objective: To compare the prevalence of increased risk of obstructive sleep apnea (OSA) in children with and without cleft lip and/or palate using a previously validated questionnaire and to examine the clinical and demographic variables that may lead to increased OSA risk. Design: Prospective, cross-sectional study. Participants: One hundred fifty-five cleft lip palate and 155 noncleft children between 2 and 18 years old. Interventions: The Pediatric Sleep Questionnaire (PSQ): Sleep Related Breathing Disorder Scale was used for screening of increased OSA risk. Age, body mass index (BMI), gender, breast-feeding, and bottle-feeding durations were recorded for all patients. Cleft type, lip and palate operation times, nasoalveolar molding, or nutrition plaque usage was documented for the cleft lip palate group. Pearson χ2 or Fisher exact test was used for the evaluation of the qualitative variables and independent samples t test or Mann Whitney U test for quantitative variables. P < .05 was accepted as statistically significant. Results: The mean ages were 7.52 ± 3.91 and 7.50 ± 3.89 years for cleft lip palate and control groups, respectively. No significant differences were observed between the groups for age, gender, or BMI. Breast-feeding duration was significantly higher, and bottle-feeding duration was lower in the control group ( P < .05). Mean PSQ score was significantly higher in cleft lip palate group (0.18 ± 0.12) than in control group (0.13 ± 0.1, P < .001); and prevalence of increased OSA risk was significantly higher in patients with both cleft lip and palate ( P = .020). Conclusions: Positive OSA screening ratio of children with cleft lip and palate (12.2%) was significantly higher than the controls (4.5%).

Craniofacial, Craniocervical, and Pharyngeal Morphology in Bilateral Cleft Lip and Palate and Obstructive Sleep Apnea Patients

2007 ◽  
Vol 44 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Barbara C. M. Oosterkamp ◽  
Hendrik J. Remmelink ◽  
Gerard J. Pruim ◽  
Aarnoud Hoekema ◽  
Pieter U. Dijkstra
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Airway Obstruction ◽  
Hyoid Bone ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Reference Group ◽  
Obstructive Sleep ◽  
Lateral Cephalograms ◽  
Bilateral Cleft Lip

Objective: The aim of this study was to analyze craniofacial, craniocervical, and pharyngeal morphology in surgically treated bilateral cleft lip and palate (BCLP) men, untreated men with obstructive sleep apnea (OSA), and a reference group of men. Subjects and methods: Lateral cephalograms were obtained of 27 male BCLP patients (mean age 29.0 ± 8.3 years), 27 untreated male OSA patients (mean age 38.6 ± 5.3 years), and 27 male controls serving as a reference group (mean age 30.8 ± 9.2 years). Tracings were made, and 26 variables representing craniofacial, craniocervical, and pharyngeal dimensions were obtained using Viewbox 3.1.1.6. software. The groups were compared using a one-way analysis of variance. Results: Craniofacial, craniocervical, and pharyngeal morphology of BCLP and OSA patients was similar except for a significantly more retrusive maxilla in the BCLP group. Compared to the reference group, the BCLP and OSA groups had significantly larger craniocervical angulations, smaller depth of the oropharynx at the tip of the velum, and a more inferiorly positioned hyoid bone. Significantly larger vertical dimensions were found in the BCLP group compared to the reference group. Conclusions: Craniofacial, craniocervical, and pharyngeal morphology of BCLP and OSA patients demonstrate substantial similarities except for a significantly more retrusive maxilla in the BCLP group. It is suggested that airway obstruction and postural adaptation to the obstruction may possibly be related to the aberrant craniofacial, craniocervical, and pharyngeal morphology in OSA and in BCLP patients.

Screening for obstructive sleep apnea in children with syndromic cleft lip and/or palate

2014 ◽  
Vol 67 (11) ◽  
pp. 1475-1480 ◽  
Author(s):  
Jason Silvestre ◽  
Youssef Tahiri ◽  
J. Thomas Paliga ◽  
Jesse A. Taylor
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cleft Lip ◽  
Obstructive Sleep

Septoplasty in Pediatric Population: A Ten Years' Experience

2020 ◽  
Vol 5 (2) ◽  
pp. 1040-1044
Author(s):  
Krishna Prasad Koirala
Keyword(s):  
Nasal Septum ◽  
Residual Disease ◽  
Pediatric Population ◽  
Adult Population ◽  
Septal Deviation ◽  
Facial Growth ◽  
Nasal Breathing ◽  
Deviated Nasal Septum ◽  
Female Ratio ◽  
Septal Surgery

Introduction: Septoplasty is a commonly performed surgical procedure worldwide in otorhinolaryngology. Septoplasty aims to correct the deviated nasal septum at the midline thereby opening the nasal airway in patients with long standing nasal obstruction secondary to septal deviation. Nasal breathing is important for proper facial growth and improvement of quality of life in children. Most surgeons are still reluctant to perform septoplasty in children. But septoplasty should be performed in children if there are severe breathing problems related to septal deviation. Objectives: The objectives of this study were to identify the incidence of children presenting with symptomatic nasal septal deviation and to analyze the early outcomes of septal surgery in children with regard to improvement in nasal symptoms, residual disease and need for revision surgery. Methodology: Children less than seventeen years of age who underwent septoplasty for symptomatic DNS from 1st January 2009 to 31st December 2018 were enrolled in the study. Patients having the follow up record of at least 6 months after surgery were included in the final analysis. Results: There were 37 male and 13 female children enrolled in the study. Male to female ratio was 2.84:1.Majority of children in the study were of 13 years (24%). Left sided DNS was seen in 28 children and right sided DNS in 22 children. Bleeding requiring re-packing, septal hematoma, recurrent DNS, synechia and septal perforation were the common complications, which were comparable to adult population. Conclusion: Early correction of the obstructed nose due to deviated nasal septum is essential to provide normal nasal breathing, relieve complications of mouth breathing and to promote normal craniofacial growth. Septoplasty can be performed in pediatric population with relatively good results without occurrence of nasal deformity and equal complications as that in adults.

scholarly journals Incidence of positive screening for obstructive sleep apnea in patients with isolated cleft lip and/or palate

2014 ◽  
Vol 22 (4) ◽  
pp. 259-263 ◽  
Author(s):  
Jason Silvestre ◽  
Youssef Tahiri ◽  
J Thomas Paliga ◽  
Jesse A Taylor
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cleft Lip ◽  
Obstructive Sleep

scholarly journals 0893 Myofunctional Therapy in Children With Mild Obstructive Sleep Apnea: A Meta-Analysis

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A340-A340
Author(s):  
A Bandyopadhyay ◽  
K N Kaneshiro ◽  
M Camacho
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Meta Analysis ◽  
Upper Airway ◽  
Mouth Breathing ◽  
Apnea Hypopnea Index ◽  
Facial Growth ◽  
Myofunctional Therapy ◽  
Obstructive Sleep ◽  
Mild Obstructive Sleep Apnea

Abstract Introduction OSA affects 2-4% of children and untreated OSA can have adverse behavior and quality of life outcomes. 40% of children can have residual obstructive sleep apnea (OSA)despite first line treatment (adenotonsillectomy). Alternative modalities of treatment for OSA are limited. Myofunctional therapy comprises of exercises targeting upper airway muscles that can improve facial growth and have been shown to treat OSA in adults. There is paucity of data on the role of myofunctional therapy (MT) in children. The objective of this study was to systematically review the literature for articles evaluating myofunctional therapy (MT) as treatment for OSA in children and to perform a meta-analysis on the polysomnographic and mouth breathing data. Methods Medline, Embase, CINAHL, Scopus, Web of Science and Cochrane were searched from inception through October 1st, 2019. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement was followed. Results Eight studies (91 patients) reported polysomnography and/or mouth breathing outcomes. The pre- and post-MT apnea hypopnea indices (AHI) decreased from a mean ± standard deviation (M ± SD) of 3.75± 3.14/h to 2.08 ± 2.48/h, mean difference (MD) -1.6 [95% confidence interval (CI) -2.42, -0.78], P =0.0001. Mean oxygen saturations improved from 96.03 ± 1.1% to 96.67 ± 0.95%, MD 0.42 (95% CI 0.21, 0.63), P &lt;0.0001. Lowest oxygen saturations improved from 86.6 ± 7.3% to 90.94 ± 3.05%, MD 1.01 (95% CI 0.25, 1.77), P = 0.009. Mouth breathing decreased in all three studies reporting subjective outcomes. Conclusion Current literature demonstrates that myofunctional therapy decreases apnea-hypopnea index by approximately 45% in children with mild obstructive sleep apnea. Mean oxygen saturations, lowest oxygen saturations and mouth breathing outcomes improved in children. Myofunctional therapy could serve as an adjunct to other obstructive sleep apnea treatments. Support None

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