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Updated: Jul 13, 2026
07:54
Drug-Induced Sleep Endoscopy (DISE) with Target Controlled Infusion (TCI) and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
Pharyngeal flap and obstructive apnea: maximizing speech outcome while limiting complications
Burke E Chegar1, Robert J Shprintzen, Michael S Curtis
1Center for Facial Plastics Head and Neck Surgery, Fayette Regional Health System, Connersville, Indiana, USA.
Archives of Facial Plastic Surgery
|July 20, 2007
Summary
A staged approach combining adenotonsillectomy and a superiorly based pharyngeal flap significantly reduced obstructive sleep apnea complications. This method maintained excellent speech results in patients with velopharyngeal insufficiency.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Speech Pathology
Background:
- Velopharyngeal insufficiency (VPI) affects speech and can be associated with obstructive sleep apnea (OSA).
- Pharyngeal flap surgery is a common treatment for VPI, but carries risks of OSA.
- A staged surgical approach may mitigate these risks.
Purpose of the Study:
- To evaluate speech outcomes and OSA incidence after a modified pharyngeal flap procedure.
- The procedure was performed after staged adenotonsillectomy in children with VPI.
Main Methods:
- Retrospective case series of 54 children undergoing staged adenotonsillectomy followed by pharyngeal flap surgery.
- Modified flap: short, superiorly based, width-customized.
- OSA assessed via cardiopulmonary/oximetry data and clinical follow-up; speech evaluated at 6-month intervals.
Main Results:
- No immediate post-operative apnea occurred.
- 94% of patients achieved resolution of VPI.
- Only 4 cases of loud snoring were noted long-term; polysomnography was negative for OSA.
- Minor complications included bleeding in 3 patients.
Conclusions:
- A staged surgical approach, including adenotonsillectomy prior to a modified superiorly based pharyngeal flap, effectively treats VPI.
- This technique significantly reduces OSA complications while ensuring excellent speech.
- Superior advancement of posterior pharyngeal wall tissue for donor site closure is a key element.
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