Postoperative airway findings after maxillomandibular advancement for obstructive sleep apnea syndrome

Objective: To evaluate the upper airway characteristics in the early postop erative period after maxillomandibular advancement for obstructive sleep ap nea syndrome. Methods: Nasopharyngolaryngoscopy was performed before and 48 hours after surgery on 70 consecutive patients who underwent maxillomandib ular advancement for obstructive sleep apnea syndrome, The preoperative and the postoperative evaluations were performed by the same examiner for cons istency. Results: Mild to moderate lateral pharyngeal wall edema was identi fied in 70 consecutive patients. Fourteen patients (20%) had edema as well as ecchymosis involving the pyriform sinus and aryepiglottic fold. Four of these patients (6%) were also noted to have hypopharyngeal hematoma involvi ng the pyriform sinus, aryepiglottic fold, arytenoid, and false vocal cord that partially obstructed the airway. These four patients were closely moni tored for 1 to 2 additional days for possible expanding hematoma leading to airway compromise. None of these patients were found to have airway diffic ulty, and the minimum oxygen saturation was more than 90% throughout the ho spitalization. All four patients were discharged uneventfully, and the hema toma resolved completely within 10 days. Conclusion: Although postoperative edema was expected after maxillomandibular advancement, hypopharyngeal hem atoma was unexpected. Although none of our patients had evidence of airway difficulty, the possibility of an expanding hypopharyngeal hematoma should be considered in patients complaining of breathing difficulty after maxillo mandibular advancement surgery.