Incidence and sequelae of nocturnal respiratory obstruction following posterior pharyngeal flap operation

A competent velopharyngeal mechanism is important for the production of nor mal speech, and the secondary procedure of a posterior pharyngeal flap (PPF ) may be necessary in some patients to achieve this goal. A number of compl ications have been described in the literature following pharyngeal flap su rgery. The purpose of this study was to examine short- and long-term compli cations after PPF surgery, and in particular the incidence and the end effe ct of nocturnal respiratory obstruction (NRO). All PPFs over a 17-year peri od performed at one institution and by the same surgeon were examined retro spectively. All medical records from the Commission of Handicapped Children of patients who had a PPF were reviewed. Patients with NRO were identified clinically, and sleep studies were administered with two or more of the cl inical triad. During a 17-year period, 111 patients underwent a PPF to trea t velopharyngeal incompetence. Twelve patients were identified with a syndr omic association in addition to a clefting disorder, of which most (N = 9) consisted of Pierre Robin syndrome. The median age at PPF performance was 6 .0 years and the average follow-up was 7.4 years. The early postoperative c omplication rate was 10%, including a 7.2% incidence of respiratory obstruc tion and 0.9% postoperative bleeding. Twenty-one patients (19%) had late co mplications or unsatisfactory results. Twelve patients (10.5%) developed NR O, and patients with Pierre Robin syndrome were particularly prone-4 of 9 p atients developed this complication. Nine of 12 patients with NRO had sleep studies performed with a minimum interval of 6 months postoperatively. Eig ht of the nine studies were normal. Of the NRO group, 3 patients had takedo wn of their PPF, including the patient with an abnormal sleep study. All 3 patients improved markedly and none developed recurrence of velopharyngeal insufficiency. NRO is not an uncommon finding in PPF patients, but NRO does not necessarily imply the presence of obstructive sleep apnea. The consequ ences of persistent NRO over the long term deserve further study.