Airway Hazards Associated With Pharyngeal Flaps in Patients Who Have the Pierre Robin Syndrome

Jackson, Paul P.; Whitáker, Linton A.; Randall, Peter

doi:10.1097/00006534-197608000-00007

Cited by 51 publications

(15 citation statements)

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“…Si bien ha habido esfuerzos por mejorar los aspectos ventilatorios asociados a las técnicas de faringoplastias, 10 existe evidencia documentada de obstrucción de la vía aérea a consecuencia de tratamientos quirúrgicos que utilizan el lumen de la faringe, como la misma técnica de Furlow, 2,11,12 aparición de trastornos cardiovasculares e incluso muerte postoperatoria en pacientes portadores de síndromes como el Velocardiofacial o una A. de Pierre Robin. 13,14 Hasta hace poco, los ronquidos no eran considerados como un signo clínico patológico y la Medicina del Sueño aún no aparecía en el espectro de las disciplinas clínicas. Hoy, sin embargo, sabemos que el ronquido durante el sueño constituye un signo clínico que puede ser relevante dentro de la patología obstructiva del sueño y que las enfermedades del sueño tienen una elevada prevalencia en la sociedad, llegando en países desarrollados a afectar según algunos cálculos, entre un 5% y un 10% de la población.…”

Section: Discussionunclassified

Veloplastia funcional secundaria: Una alternativa no obstructiva en el tratamiento de la insuficiencia velofaríngea

Araya

Duarte²,

Hsieh

et al. 2004

Rev Esp Cirug Oral y Maxilofac

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Resumen: Introducción. La insuficiencia velofaríngea es quizá la secuela más común de las técnicas de veloplastia realizadas para la corrección de las fisuras palatinas. A menudo la terapia fonoaudiológica se encuentra limitada, obteniéndose generalmente sólo resultados parciales. En estos casos la faringoplastia se presenta como el tratamiento de elección, existiendo diversas técnicas publicadas. Éstas, cualesquiera que sean, tienen en común la utilización de colgajos faríngeos que determinan una reducción del diámetro de la vía aérea superior con el consiguiente riesgo de generar un trastorno obstructivo del sueño. Objetivos. En el ánimo de obviar esta situación y simultáneamente alargar y dar competencia velopalatina, se ha diseñado una técnica quirúrgica que tiene por objetivo la reconstrucción morfofuncional velar o veloplastia funcional secundaria, inspirada en los principios de Delaire. Material y técnica quirúrgica. Presentamos nuestra experiencia basada en una serie de 15 casos tratados de esta nueva manera: se divide completamente el paladar blando, incindiendo sobre la línea media y exponiendo ambos hemivelos hasta la región retrouvular. En ese momento se busca e identifican las estructuras musculares remanentes, se separan del borde óseo palatino y de las mucosa nasal y bucal y se unen en una posición más posterior con las contralaterales en la línea media. Resultados. En nuestra experiencia se ha logrado el alargamiento velopalatino y la corrección o mejoramiento de rinolalias. En la evaluación de resultados hemos utilizado tanto el examen clínico fonoaudiológico como la aerofonoscopía con muy buenos resultados comparativos.

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Section: Discussionunclassified

Veloplastia funcional secundaria: Una alternativa no obstructiva en el tratamiento de la insuficiencia velofaríngea

Araya

Duarte²,

Hsieh

et al. 2004

Rev Esp Cirug Oral y Maxilofac

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“…In patients presenting for palatoplasty, postoperative ligual swelling is associated with difficult repair during which limited surgical access demands forceful and lengthy tongue retraction. This is particularly true in Pierre-Robin syndrome, where micrognathia and glossoptosis present major difficulties in surgical exposure [3,131. The length of surgery in all six previously reported cases was greater than 3.5 h. In 34 consecutive 'normal palatoplasty' operations performed in our institution for the period February-June 1993, in which no lingual swelling was detected clinically, the duration of surgery was 2.2 (1.1-3.…”

Section: Discussionmentioning

confidence: 99%

“…Haemorrhage and airway obstruction are the most frequent major complications [2]. Upper airway obstruction after cleft palate repair is most commonly associated with laryngospasm, but it is also a well recognised complication in patients with pre-existing craniofacial anomalies such as Pierre-Robin syndrome [3] and following primary pharyngeal flap reconstruction [4, 51. Life-threatening airway obstruction as a result of lingual swelling is unusual.…”

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confidence: 99%

Massive lingual swelling following palatoplasty

Chan

Mui

et al. 1995

Anaesthesia

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SummaryWe report a case of upper airway obstruction as a result of delayed massive lingual swelling following routine cleft palate repair in an otherwise healthy 12-month-old girl. We believe that ischaemia and venous congestion were the causes of macroglossia, after prolonged use of the Digman Dott tongue retractor. In any dificult and lengthy repair, we recommend the prophylactic insertion of a nasopharyngeal airway under direct vision by the surgeons after surgery to prevent potential upper airway obstruction. Key wordsAnaesthesia; paediatric. Complication; macroglossia. Airway; obstruction. Surgery; cleft palate.Palatoplasty is a relatively common procedure and the overall incidence of postoperative morbidity varies from 15 to 26% [I, 21. Haemorrhage and airway obstruction are the most frequent major complications [2]. Upper airway obstruction after cleft palate repair is most commonly associated with laryngospasm, but it is also a well recognised complication in patients with pre-existing craniofacial anomalies such as Pierre-Robin syndrome [3] and following primary pharyngeal flap reconstruction [4, 51. Life-threatening airway obstruction as a result of lingual swelling is unusual. Re-establishment of an adequate airway can be extremely difficult, if not impossible. In this report, we describe a case of massive lingual swelling shortly after routine palatoplasty in an otherwise normal child and we review the potential risk factors, pathogenesis, clinical course, preventive measures and the management of this complication. Case historyA 12-month-old, 8.6 kg girl presented for elective cleft palate repair. She had been delivered vaginally at term following an uncomplicated pregnancy. Her birth weight was 2.58 kg and she had a complete bilateral cleft palate. Apart from recurrent middle ear infections and delayed phonologic development, her perinatal history was uneventful. Pre-operatively, physical examination revealed a healthy girl with a central, wide soft palate cleft, but an otherwise normal airway. She was given premedication of trimeprazine 24 mg orally, 30 min before surgery.Following inhalational induction with isoflurane in oxygen and nitrous oxide, an intravenous infusion of 0.18% saline in 4.3% dextrose was started at 40ml.h-'. After administration of atracurium 5 mg and fentanyl 10 pg intravenously, the trachea was intubated easily with a 4.0-mm uncuffed oral-RAE tube (Mallinckrodt Lab. Ltd. Athlone, Ireland).The child was placed in the Trendelenberg position, with the neck hyperextended. A Digman Dott self retaining tongue retractor was inserted to optimise surgical exposure. The cleft edge was infiltrated with lignocaine 0.5% 5ml with 1 : 200 000 adrenaline. A V-Y pushback palatoplasty was performed. The operation was technically difficult because of the large cleft and relatively small mouth. The entire procedure lasted 3 h and 45 min, with the tongue retractor in place during most of the operation. Total blood loss was approximately 60 ml and was replaced with 70 ml of stable plasma protein ...

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“…Como já mencionado anteriormente, muitos autores comprovaram o elevado sucesso da cirurgia de retalho faríngeo na redução ou eliminação dos sintomas de fala conseqüentes da IVF (Smith et al 1963, Subtelny et al 1970, Owsley Junior et al 1970, Schulz et al 1973, Leanderson et al 1974, Brondsted et al 1984 Segundo Graham et al (1973), Jackson et al (1976), Abransom et al (1997) e Wells et al (1999), maior cuidado ainda deve ser tomado quando o retalho faríngeo é realizado em pacientes portadores de síndromes associadas à fissura. Kravath et al (1980) De acordo com Shprintzen (1988), muitas destas síndromes que incluem a fissura, estão associadas ao estreitamento estrutural da via aérea faríngea, como a Seqüência de Robin, ou à hipotonia da faringe, como na síndrome velocardiofacial, que podem levar a complicações tanto trans-operatórias como pós-operatórias.…”

Section: Revisão De Literaturaunclassified

Dimensões nasofaríngeas e queixas respiratórias em indivíduos com insuficiência velofaríngea submetidos à cirurgia de retalho faríngeo

Yamashita¹

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Airway Hazards Associated With Pharyngeal Flaps in Patients Who Have the Pierre Robin Syndrome

Cited by 51 publications

References 0 publications

Veloplastia funcional secundaria: Una alternativa no obstructiva en el tratamiento de la insuficiencia velofaríngea

Veloplastia funcional secundaria: Una alternativa no obstructiva en el tratamiento de la insuficiencia velofaríngea

Massive lingual swelling following palatoplasty

Dimensões nasofaríngeas e queixas respiratórias em indivíduos com insuficiência velofaríngea submetidos à cirurgia de retalho faríngeo

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