Fiberoptic nasopharyngolaryngoscopy for airway monitoring after obstructive sleep apnea surgery

Purpose: This study evaluated the upper airway characteristics in the early postoperative period after reconstructive surgery for obstructive sleep ap nea (OSA). Methods: During a 24-month period, the upper airway of patients who underwe nt uvulopalatopharyngoplasty (UPPP) with genioglossus advancement (GA) or h yoid myotomy (HM) or maxillomandibular advancement (MMA) were evaluated wit h fiberoptic nasopharyngolaryngoscopy (NPG) preoperatively and 24 to 72 hou rs postoperatively. Results: NPG was performed on 271 patients. One hundred seventy-three patie nts had UPPP with GA or HM, and the remainder had MMA. All of the patients who underwent UPPP with GA or HM were found to have varying degrees of soft tissue edema involving the soft palate and the tongue base. The patients w ho underwent tonsillectomies and UPPP with GA or HM had greater soft palate /pharyngeal wall edema. In contrast, patients who underwent MMA had minimal edema involving the soft palate and the base of tongue, but diffuse latera l pharyngeal wall edema throughout the upper airway was identified. Eightee n of the MMA patients had ecchymosis and edema involving the pyriform sinus and arygepiglottic fold; 4 of these patients also had a hypopharyngeal hem atoma involving the pyriform sinus, aryepiglottic fold, arytenoid, and fals e vocal cord, which partially obstructed the airway. These 4 patients were closely monitored for 1 to 2 additional days, and all were discharged witho ut problems. None of the patients in the study had postoperative airway obs truction. Conclusion: NPG may be useful in postoperative airway monitoring and assist in discharge planning after upper airway reconstruction in the OSA patient s. (C) 2000 American Association of Oral and Maxillofacial Surgeons.