UPPER AIRWAY-OBSTRUCTION AFTER PHARYNGEAL FLAP SURGERY

Upper airway obstruction after superiorly based pharyngeal flap proced ures for the treatment of velopharyngeal insufficiency is described in this series of 32 flaps performed in 29 patients at our institution b etween 1979 and 1993, A high incidence of upper airway obstruction sym ptoms (38%) occurred in the early postoperative period but resolved in all but 2 patients within 5 months. None of the patients required fla p revision or other procedures for relief of upper airway obstruction, Velopharyngeal insufficiency was improved or completely eliminated in 87% of patients, Significant residual velopharyngeal insufficiency in 13% of patients was treated successfully in all flap revision cases, Race, gender, age at closure, and associated craniofacial anomalies di d not correlate with upper airway obstruction or with the efficacy of treatment for velopharyngeal insufficiency, However, patients with tra nsient postoperative upper airway obstruction were only half as likely to suffer residual postoperative velopharyngeal insufficiency. The in verse relationship between velopharyngeal insufficiency and upper airw ay obstruction (p = .008) suggests that the surgeon may sometimes need to accept some transient upper airway obstruction to achieve correcti on of velopharyngeal insufficiency.