A preoperative sleep study with nasal airway occlusion in pharyngeal flap surgery

Morita, Takeshi; Kurata, Kyosuke; Hiratsuka, Yasuyuki; Ito, Juichi

doi:10.1016/j.amjoto.2004.04.006

Cited by 7 publications

(10 citation statements)

References 18 publications

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“…Several authors give account of postoperative sleep apnea (OSAS) which is a major complication of pharyngeal flap surgery [41]. Ysunza et al [60] found 15 OSAS with polysomnography in 585 cases after (velo-) pharyngoplasty, Valnicek et al [36] 9 cases among 219 children.…”

Section: Discussionmentioning

confidence: 99%

“…If this intervention is not enough, very rarely, cutting through the flap may come up. Preoperative sleep study with complete nasal obstruction with nasal tampons could be useful for predicting the risk of upper airway obstruction secondary to pharyngeal flap surgery [41]. We suggest polysomnographic investigations before pharyngeal flap surgery and also before palatoplasty in retrognathic children to predict the probable postoperative breathing problems.…”

Section: Discussionmentioning

confidence: 99%

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Results and Complications of 1104 Surgeries for Velopharyngeal Insufficiency

Hirschberg

2012

ISRN Otolaryngology

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Velopharyngeal insufficiency (VPI) means that the velopharyngeal closure is inadequate or disturbed. VPI may be organic or functional, congenital or acquired and is caused by structural alterations or paresis. The symptoms are primarily to be found in speech (hypernasality), more rarely in swallowing and hearing. The management types are as follows: speech therapy, surgery, speech bulb, and others. Surgery is indicated if the symptoms of VPI cannot be improved by speech therapy. Among the operative methods, velopharyngoplasty constitutes the basis of the surgery. The pharyngeal flap was incorporated and survived in 98.1% of the cases, hyperrhinophony disappeared or became minimal in 90% after surgery in our material (1104 cases). The speech results seemed to be the same with superiorly or inferiorly based pharyngeal flap. The Furlow technique, push-back procedure, the sphincteroplasty, and the augmentation were indicated by us if the VP gap was less than 7 mm; these methods may also be used as secondary operation. We observed among 1104 various surgeries severe hemorrhage in 5 cases, aspiration in 2 cases, significant nasal obstruction in 68 patients, OSAS in 5 cases; tracheotomy was necessary in 2 cases. Although the complication rate is rare, it must always be considered that this is not a life-saving but a speech-correcting operation. A tailor-made superiorly based pharyngeal flap is suggested today, possibly in the age of 5 years.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Results and Complications of 1104 Surgeries for Velopharyngeal Insufficiency

Hirschberg

2012

ISRN Otolaryngology

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“…The severity of the airway obstructive effect is usually at its maximum in the early postoperative period; it may be increased by edema. [14][15][16] In our study, 3 out of 15 patients developed obstructive sleep apnea that improved spontaneously after 2 months. However, the mechanical obstructive effect of pharyngeal flap is less when the flap is lateralized than when it is bridging the middle part of the velopharynx.…”

Section: Discussionmentioning

confidence: 78%

Lateralization of the Pharyngeal Flap for Treatment of Lateral Velopharyngeal Gap

Abdel‐Aziz

Rashed²,

Naguib³

et al. 2016

Journal of Craniofacial Surgery

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Pharyngeal flap is usually used for treatment of velopharyngeal insufficiency (VPI); it is bridged between the posterior pharyngeal wall and the soft palate traversing the central part of the velopharyngeal port. The aim of this study was to assess the efficacy of lateralization of the pharyngeal flap for treatment of VPI in patients with lateral velopharyngeal gap. Fifteen patients with VPI due to lateral velopharyngeal gap were subjected to closure of the gap by pharyngeal flap that was lateralized to fill the gap. Preoperative and postoperative assessment of velopharyngeal functions including flexible nasopharyngoscopy, auditory perceptual assessment (APA), and nasometric assessment were performed. Postoperatively, flexible nasopharyngoscopy showed complete velopharyngeal closure in all the patients, with significant improvement of speech parameters as measured by APA. Also, nasalance score showed significant improvement for oral and nasal sentences that was measured by nasometry. Lateralization of the pharyngeal flap for treatment of VPI in patients with lateral velopharyngeal gap is an effective method; it improves the velopharyngeal closure and the speech of the patients.

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“…In the group of AT surgical studies, 5 provided Level 2 63,76,96,97,121 evidence, 9 provided Level 3 30,59,66,80,[122][123][124][125][126] evidence, and 9 provided Level 4 43,71,88,[127][128][129][130][131][132] evidence. In the other surgical group, 1 study provided Level 3 133 evidence and 7 provided Level 4 [134][135][136][137][138][139][140] evidence. In the group of nonsurgical interventions, 4 provided Level 2 [141][142][143][144] evidence, 4 provided Level 3 60,[145][146][147] evidence, and 3 provided Level 4 52,148,149 evidence.…”

Section: Therapeutic Intervention Studies That Provide Evidence Of Test-retest Validitymentioning

confidence: 99%

Executive Summary of Respiratory Indications for Polysomnography in Children: An Evidence-Based Review

Wise¹,

Nichols²,

Grigg-Damberger³

et al. 2011

Sleep

154

102

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Pediatric polysomnography shows validity, reliability, and clinical utility that is commensurate with most other routinely employed diagnostic clinical tools or procedures. Findings indicate that the "gold standard" for diagnosis of sleep related breathing disorders in children is not polysomnography alone, but rather the skillful integration of clinical and polygraphic findings by a knowledgeable sleep specialist. Future developments will provide more sophisticated methods for data collection and analysis, but integration of polysomnographic findings with the clinical evaluation will represent the fundamental diagnostic challenge for the sleep specialist.

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A preoperative sleep study with nasal airway occlusion in pharyngeal flap surgery

Cited by 7 publications

References 18 publications

Results and Complications of 1104 Surgeries for Velopharyngeal Insufficiency

Results and Complications of 1104 Surgeries for Velopharyngeal Insufficiency

Lateralization of the Pharyngeal Flap for Treatment of Lateral Velopharyngeal Gap

Executive Summary of Respiratory Indications for Polysomnography in Children: An Evidence-Based Review

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