Changes in airflow dynamics after creation of pharyngeal flaps in nonsyndromic children

Velopharyngeal insufficiency is a common problem in the cleft palate population that may require a pharyngeal flap. Sleep disordered breathing is a common complication of this surgery and a baseline sleep study is often performed before undergoing the procedure. Few postoperative sleep studies are ever done and little is known about the effects that pharyngeal flaps have on airflow dynamics.Preoperative and postoperative nasometry and polysomnographic data were reviewed and compared from nonsyndromic children requiring pharyngeal flap since 2009. Eighteen children having undergone pharyngeal flap were identified. Of those 18, Nadir oxygen saturations were worsened in 10, improved in 7, and remained the same in 1. Snoring was caused or made worse in 8. Sleep efficiency was worse in 11, improved in 6, and remained the same in 1. Apnea/hypopnea events increased in 9 and decreased in the other 9. Hypernasality was improved in varying degrees in 17 patients, but all required additional speech therapy. Diagnosed preoperative sleep apnea remained in 1 patient. No patient's postpharyngeal flap had any significant sleep disturbance that would warrant continuous positive airway pressure. No flaps required division or takedown.This preliminary study suggests that pharyngeal flaps may increase snoring and apnea/hypopnea events without causing diagnosable sleep disordered breathing and the resultant clinical sequelae. Nasometry shows evidence of nasal airway diversion without complete obstruction. Speech improves more subjectively than nasometry would predict after pharyngeal flap.