OBSTRUCTIVE SLEEP-APNEA SECONDARY TO SURGERY FOR VELOPHARYNGEAL INSUFFICIENCY

The files of 585 patients who had had pharyngeal flap surgery for the correction of velopharyngeal insufficiency were reviewed. Eighteen pat ients, ranging in age from 6 to 16 years, showed clinical symptoms of obstructive sleep apnea syndrome. All of these cases had a polysomnogr aphic evaluation and videonasopharyngoscopy. Fifteen cases met the cri teria for the diagnosis of obstructive sleep apnea syndrome and eventu ally underwent surgical treatment. A modified uvulopalatopharyngoplast y was done in 14 of the 15 cases. One patient had a prominent uvula fl ipping into the port of a Jackson's type pharyngoplasty, so a partial resection of the uvula was performed. Surgical treatment was successfu l in 14 of 15 cases, including the case with the partial uvular resect ion. In one case, severe sleep apnea persisted after surgery and a com plete section of the flap was performed to correct the obstruction. Si zeable tonsils were found in 13 out of 15 cases, whereas flap width ap peared unrelated to obstruction. Preoperative assessment of tonsillar tissue is of vital importance before pharyngeal flap surgery.