ACUTE OBSTRUCTIVE SLEEP-APNEA AS A COMPLICATION OF SPHINCTER PHARYNGOPLASTY

This report describes postoperative airway compromise following sphinc ter pharyngoplasty (SP) for treatment of post-palatoplasty velopharyng eal dysfunction. A retrospective review of 58 SPs performed for post-p alatoplasty velopharyngeal dysfunction, on 30 male, and 28 female pati ents, over a 5-year study period was undertaken at a tertiary referral academic institution (Washington University School of Medicine), at t he St. Louis Children's Hospital, Cleft Palate and Craniofacial Deform ities Institute. Eight patients were identified who had the following inclusion criteria: overt perioperative and/or postoperative airway dy sfunction, identifiable syndromes, or microretrognathia. Items reviewe d were patient demographic factors, associated medical problems, genet ics evaluations, nasendoscopic characteristics of velopharyngeal closu re, anesthetic evaluation of the patients, and the incidence and sever ity of perioperative complications. Particular attention was paid to f actors contributing to the airway obstruction. Of the eight subjects w ith perioperative and/or postoperative upper airway dysfunction follow ing SP, five patients had Pierre Robin sequence/micrognathia, while th ree patients had a history of perinatal respiratory and/or feeding dif ficulties without micrognathia or an identified genetic disorder. All but two episodes of airway dysfunction resolved within 3 days postoper atively. These patients were discharged home with apnea monitors; both were readmitted with recurrent airway dysfunction. Continuous positiv e airway pressure (CPAP) was utilized successfully in all instances, a nd no patients required take-down of the SP to relieve airway dysfunct ion. CPAP is an effective, noninvasive treatment strategy for manageme nt of iatrogenically induced apnea following SP, without sacrificing t he surgical benefit of improved speech intelligibility.