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Published on: November 30, 2010
Safety of nasal stenting in pharyngeal flap surgery for pediatric velopharyngeal dysfunction
R Araslanova1, R Instrum1, A Dzioba1
1Department of Otolaryngology-Head and Neck Surgery, Western University, Canada.
Insights
Routine nasal stenting is safe for children undergoing pharyngeal flap surgery for velopharyngeal dysfunction (VPD). This approach did not increase complications and warrants further study for airway safety.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Speech and Language Pathology
Background:
- Pharyngeal flap surgery effectively treats velopharyngeal dysfunction (VPD).
- A significant risk of post-operative airway obstruction (3.2%) exists, particularly within 24 hours.
- Nasopharyngeal airways can mitigate these risks but are not routinely used.
Purpose of the Study:
- To evaluate the safety and efficacy of routine bilateral nasal stenting in pediatric patients undergoing pharyngeal flap surgery for VPD.
- To demonstrate that nasal stenting is a safe adjunct to pharyngeal flap surgery in children.
Main Methods:
- Retrospective review of 85 pediatric patients (aged 1-18) who had pharyngeal flap surgery.
- Analysis of demographic data, perioperative complications, and patient outcomes.
- Patients admitted to a regular ward with monitoring; nasal stents removed on post-operative day two.
Main Results:
- No patients required intensive care unit admission or experienced post-operative airway obstruction.
- Minor stent-related complications occurred in 5.9% of patients (e.g., epistaxis, granuloma), all resolved without impacting hospital stay.
- Two patients (2.3%) required pharyngeal flap reversal for obstructive sleep apnea or persistent nasal obstruction.
Conclusions:
- Routine nasal stenting in conjunction with pharyngeal flap surgery is safe for pediatric patients.
- Stent-related complications were minor and did not prolong hospitalization.
- Further prospective studies are recommended to confirm reduced serious airway complications with routine stenting.
Introduction:
The pharyngeal flap procedure is an effective surgery for velopharyngeal dysfunction (VPD) yet carries approximately a 3.2% post-operative airway obstruction risk. Life threatening airway compromise occurs in first 24 h post-operatively. Nasopharyngeal airway has been shown to decrease these complications but its routine use is not commonplace. At our centre, surgical technique involves routine placement of bilateral nasopharyngeal airway referred to as nasal stenting. Our objective was to demonstrate safety of nasal stenting for children with VPD undergoing pharyngeal flap surgery.
Methods:
A retrospective review of pediatric patients aged 1 through 18 years at the time of VPD diagnosis, who underwent superiorly based pharyngeal flap surgery at London Health Sciences Centre (LHSC), was conducted. Patients were admitted to a regular ward with bihourly oxygen saturation checks. Nasal stents were removed on post-operative day two. Demographic data along with patient outcomes and perioperative complications were collected and analyzed.
Results:
Eighty-five pediatric patients underwent superiorly based pharyngeal flap surgery at LHSC from November 2004 through February 2017 that met inclusion criteria. Mean age at the time of surgery was 11.0 years, whereas average age at diagnosis was 8.7 years. The majority of patients (60.0%) had history of cleft palate repair. Only 28.2% had additional comorbidities, the most common being Pierre-Robin Sequence. Average length of hospital stay was 2.7 days. No patients required admission to an intensive care unit. Surgical complication rate was 8.2%. No post-operative airway obstruction events were encountered. Two patients (2.3%) underwent pharyngeal flap reversal for obstructive sleep apnea and one for persistent nasal obstruction. Five (5.9%) minor stent-related complications were captured. Two patients developed self-limiting epistaxis. Two patients had partially extruded stents prior to their removal. One patient developed nasopharyngeal port granuloma which resolved with a course of intranasal corticosteroids.
Conclusion:
Nasal stenting for pharyngeal flap surgery is safe. Stent related complications were minor and did not influence length of hospital stay. A prospective study to determine if routine stenting would lead to decreased serious airway complications is warranted.
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