Post-operative respiratory distress following primary cleft palate repair

Abstract

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.

Obstructive sleep apnoea in children with craniofacial syndromes

“…The effect of primary palatoplasty on upper airway obstruction has not been well studied, but there is some evidence that children who have OSAS pre-operatively are at risk for developing perioperative airway complications 19 .…”

Evaluating the Need for Routine Admission following Primary Cleft Palate Repair

“…15 These findings are corroborated by other studies that demonstrated the highest risk of respiratory and hemorrhagic complications to occur in the first 48 hours following repair. 12,32 The presence of a syndromic diagnosis or comorbidity also increased the risk of a postoperative event and the need for postoperative admission in our patients. This is consistent with other reports.…”

“…34 There is evidence that recovery may be expedited with inpatient care, as parents or guardians may feel more comfortable in a setting that enables access to experienced hospital staff, 35 capable of providing competent postoperative care and faster return to normal function. As suggested by other authors, 32 the presence of such medical staff during the postoperative period is equally as important as proper preoperative evaluation and intraoperative management, particularly with regard to provision of an environment adequate for monitoring and responding to an airway obstruction event. In contrast, there are also studies demonstrating the advantages of early discharge and/or outpatient surgery, over and above the financial benefits.…”

OSAS in Specific Pediatric Populations

“…The effect of primary palatoplasty on upper airway obstruction has not been well studied, but there is some evidence that children who have OSAS pre-operatively are at risk for developing perioperative airway complications. 63 As many as 13% of children with cleft palate develop velopharygneal insufficiency after primary palatoplasty, causing hypernasal voice and swallowing dysfunction. Correcting velopharyngeal insufficiency usually involves one of several additional palate operations.…”