Pharyngeal Flap Surgery - Complications

Complications

The most common complications of pharyngeal flap surgery include airway obstruction and sleep apnea (Pena, 2000). Snoring has also been noted as a possible negative outcome of the surgery (Sloan, 2000). As a result of flap surgery, the airway is compromised in several ways. Some of the issues associated with this compromise include: narrowing of the nasal and oral airway secondary to edema, impeding of the nasopharynx by the flap itself, anatomical changes in which the oropharynx becomes smaller, and decreased respiratory drive following anesthesia. There is also a correlation between the individuals who have this surgery and the presence of other craniofacial and neurological conditions. These factors together may lead to the above complications (Pena, 2000).

Postoperative airway obstruction may range from mild stridor events to severe blockage of the airway resulting in intubation or tracheostomy. All patients should be closely monitored following surgery due to the possible damage to the newly repaired palate or even the risk of death. In the literature, airway obstruction following pharyngeal flap surgery using the Wardill-Kilner and von Langenbeck techniques are well documented. It has been concluded that individuals with Franceschetti syndrome or Pierre Robin sequence are at increased risk for developing airway obstruction following pharyngoplasty due to their shallow nasopharyngeal airway and inadequate maxillofacial growth at the time of the surgery. It is also believed that prolonged duration of the surgical procedure may be directly correlated with an increased incidence of airway obstruction. Age does not seem to influence the risk. Factors that increase the risk of airway obstruction include associated congenital anomalies and a history of airway problems (Anthony & Sloan, 2002).

Sleep apnea can be categorized as obstructive sleep apnea (OSA) or central sleep apnea. The potential health risks of OSA are severe and therefore even a small percentage of incidence is considered significant. Obstructive sleep apnea symptoms must be carefully assessed following pharyngeal flap surgery (Ysunza). This condition was found to be more commonly linked to posterior pharyngeal flap surgery, however, pharyngeal flaps are considered to be more valuable in correcting velopharyngeal function than other treatment options, especially in severe cases of VPI (Sloan, 2000). It has also been reported that large tonsils have been found in a high percentage of OSA cases. Large tonsils may be shifted posteriorly, under the ports of the flap. In superiorly-based pharyngeal flaps, tonsils are a likely contributor to OSA. Surgical procedures such as uvulopalatopharyngoplasties and tonsillectomies may be required to resolve the OSA. Consequently, tonsillar tissue is an important area of pre-operative assessment (Ysunza et al., 1993).