The impact of adenoid size on rate of revision sphincter pharyngoplasty

O’Connell, Brendan P.; Dobbie, Allison; Oyer, Samuel L.; Montiel, Melissa; Hufnagle, Kathryn; Patel, Krishna G.; Discolo, Christopher M.; Nguyen, Shaun A.; White, David R.

doi:10.1002/lary.24683

Cited by 12 publications

(2 citation statements)

References 25 publications

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“…Significant tonsillar and adenoid hypertrophy can interfere with the proper placement of tissues during pharyngoplasty or PPF surgery. In this situation, adenotonsillectomy in preparation for VPD surgery can result in improved speech outcomes that are stable over time (O’Connell et al, 2014). Given the potential elevated baseline incidence of OSA in patients with 22q11.2DS, increased risks of OSA after VPD surgery, and that fact that adenotonsillectomy often corrects OSA and is sometimes required prior to VPD surgery, should adenotonsillectomy be performed prophylactically in patients with 22q11.2DS and severe VPD undergoing VPD surgery to minimize the risk of OSA?…”

Section: Discussionmentioning

confidence: 99%

Defining Risk of Postoperative Obstructive Sleep Apnea in Patients With 22q11.2DS Undergoing Pharyngeal Flap Surgery for Velopharyngeal Dysfunction Using Polysomnographic Evaluation

Lee

Chang

Solot

et al. 2020

The Cleft Palate-Craniofacial Journal

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Objective: To determine pre- and postoperative prevalence of obstructive sleep apnea (OSA) in patients with 22q11.2 deletion syndrome (DS) undergoing wide posterior pharyngeal flap (PPF) surgery for velopharyngeal dysfunction (VPD). Design: Retrospective study using pre- and postoperative polysomnography (PSG) to determine prevalence of OSA. Medical records were reviewed for patients’ medical comorbidities. Parents were surveyed about snoring. Setting: Academic tertiary care pediatric hospital. Patients: Forty patients with laboratory confirmed 22q11.2DS followed over a 6-year period. Interventions: Pre- and postoperative PSG, speech evaluation, and parent surveys. Main Outcome Measure: Severity and prevalence of OSA, defined by obstructive apnea hypopnea index (OAHI), before and after PPF surgery to determine whether PPF is associated with increased risk of OSA. Results: Mean OAHI did not change significantly after PPF surgery (1.1/h vs 2.1/h, P = .330). Prevalence of clinically significant OSA (OAHI ≥ 5) was identical pre- and postoperatively (2 of 40), with both cases having severe-range OSA requiring positive airway pressure therapy. All other patients had mild-range OSA. Nasal resonance was graded as severe preoperatively in 85% of patients. None were graded as severe postoperatively. No single patient factor or parent-reported concern predicted risk of OSA (OAHI ≥ 1.5). Conclusions: Patients with 22q11.2DS are medically complex and are at increased risk of OSA at baseline. Wide PPF surgery for severe VPD does not significantly increase risk of OSA. Careful perioperative planning is essential to optimize both speech and sleep outcomes.

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Section: Discussionmentioning

confidence: 99%

Defining Risk of Postoperative Obstructive Sleep Apnea in Patients With 22q11.2DS Undergoing Pharyngeal Flap Surgery for Velopharyngeal Dysfunction Using Polysomnographic Evaluation

Lee

Chang

Solot

et al. 2020

The Cleft Palate-Craniofacial Journal

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“…In cases of isolated sagittal closure, pharyngeal flaps are used. The rate of revision SP for persistent hypernasality remains between 10 and 28% [1,2] . Failure after SP is inherently characterized by persistent nasal escape during speech which can be attributed to any of the following: inappropriate height of the sphincter along the posterior pharyngeal wall, lack of sphincter bulk, or flap dehiscence.…”

Section: Introductionmentioning

confidence: 99%

Calcium Hydroxylapatite Injection for Persistent Velopharyngeal Insufficiency after Sphincter Pharyngoplasty

O’Connell¹,

Ak²,

Gudis³

et al. 2015

ORL

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Background: The role of calcium hydroxylapatite injection pharyngoplasty after failed sphincter pharyngoplasty surgery has not previously been described. We report our technique of injecting calcium hydroxylapatite into the pharyngoplasty site to add bulk to specific areas of the velopharyngeal port. Methods: A retrospective review of children undergoing calcium hydroxylapatite injection pharyngoplasty for persistent velopharyngeal insufficiency after sphincter pharyngoplasty was performed. Our surgical technique is described. Outcome measures included postoperative perceptual assessment of resonance, improvement in phoneme-specific nasometry scores, and rate of revision surgery. Results: Fourteen patients were included in the study. Improvement in hypernasality on perceptual assessment was noted in the majority of children (85.7%). The rate of achievement of normal resonance on perceptual analysis was 35.7%. A significant decrease in nasometry scores was noted for the following phonemes: /pa/, /sa/, /sha/, and /pi/. There were no intraoperative complications or immediate postoperative complications associated with calcium hydroxylapatite injection. Conclusions: Our early experience suggests that calcium hydroxylapatite injection after failed sphincter pharyngoplasty is a safe, minimally invasive technique with favorable short-term results.

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Bad Results in Cleft Palate Surgery

Rossell-Perry

2022

Atlas of Non-Desirable Outcomes in Cleft Lip and Palate Surgery

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The impact of adenoid size on rate of revision sphincter pharyngoplasty

Cited by 12 publications

References 25 publications

Defining Risk of Postoperative Obstructive Sleep Apnea in Patients With 22q11.2DS Undergoing Pharyngeal Flap Surgery for Velopharyngeal Dysfunction Using Polysomnographic Evaluation

Defining Risk of Postoperative Obstructive Sleep Apnea in Patients With 22q11.2DS Undergoing Pharyngeal Flap Surgery for Velopharyngeal Dysfunction Using Polysomnographic Evaluation

Calcium Hydroxylapatite Injection for Persistent Velopharyngeal Insufficiency after Sphincter Pharyngoplasty

Bad Results in Cleft Palate Surgery

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