Airway Obstruction following Palatoplasty: Analysis of 247 Consecutive Operations

Abstract

Objective and Methods Between February 1987 and September 1997, 247 patients underwent primary repair of a cleft of the secondary palate by one surgeon, using the double-opposing Z-plasty (Furlow) technique. This retrospective study reviews perioperative and postoperative airway compromise among these patients. The purposes of this study were to identify factors associated with airway obstruction following palatoplasty and to analyze the management of those patients. Although infants experiencing airway problems following Wardill-Kilner and Von Langenbeck palatoplasty have been described, airway complications in a group of Furlow repair patients has not been previously reported. Results Fourteen patients (5.7%) had airway problems. The average age of these patients was 18 months, which was not significantly different from those without airway problems. Airway obstruction occurred as late as 48 hours after the completion of surgery. Twelve of the 14 patients had severe airway compromise requiring continued postoperative intubation, reintubation, or tracheostomy (one). There were no deaths. Thirteen of the 14 patients with postoperative airway problems (93%) had other congenital anomalies in addition to clefting, a named congenital disorder, or both. Seven of those 13 had Pierre Robin sequence. In contrast, only 40 of the 233 patients without airway problems (17%) had additional congenital anomalies or named disorders. Presence of other congenital anomalies was associated with a significantly increased risk of airway obstruction (p = .005). Conclusion Patients with cleft palate with the Pierre Robin sequence or other additional congenital anomalies had an increased risk of airway problems following palatoplasty. Awareness of this risk permits identifying those patients prior to surgery so that they can be monitored and managed appropriately, minimizing the likelihood of major complications or death.

Sleep Disordered Breathing and Obstructive Sleep Apnea in the Cleft Population

“…Though attention is appropriately directed to the repair of the obvious deformities and correction of speech and middle ear disease, there are many reasons to suspect significant airway obstruction in these children. [1][2][3][4][5][6][7][8][9][10] In children with craniofacial deformities, airway obstruction is almost always multifactorial. This may occur at several levels, including nose, nasopharynx, and palate/oropharynx.…”

The effectiveness of tonsillectomy and partial adenoidectomy on obstructive sleep apnea in cleft palate patients

“…Rose et al23 found significant narrowing of the anterior‐posterior dimension of the pharynx in patients with cleft palate compared to non‐cleft controls, although there were no significant differences in the size of the tonsils and adenoids between the groups. Antony and Sloan24 found airway obstruction in 5.7% of cleft palate patients following palatoplasty, and reported that the risk is increased in patients with Pierre Robin Sequence or additional congenital anomalies. Indeed, Liao et al25 found no OSA in their cleft palate patients prior to repair; however, all cases demonstrated OSA during the early postoperative period.…”

Acute airway obstruction in an infant with Pierre Robin syndrome after palatoplasty

“…Patients with Pierre Robin sequence and other identified syndromes have been reported to have an increased risk of developing airway obstruction, respiratory distress, severe feeding difficulties, and even death after palatoplasty (2,3,5). Airway morbidity after Wardill-Kilner or von Langenbeck and recently Furlow repair, but not Perko-revised palatoplasty, has been described (6)(7)(8).…”

“…This case has taught us that it is wiser to postpone the extubation for 12-24 h even if the laryngoscopic evaluation of the patient does not show any significant swelling at the end of surgery. In fact, a respiratory obstruction has been described up to 36 h after surgery (8).…”