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Published on: December 6, 2016
Obstructive Sleep Apnea Following Secondary Velopharyngeal Insufficiency in Children with Non-Syndromic Cleft Palate:
Milton Chin1, Mona Haj1, Sarah L Versnel2
1Department of Maxillofacial Surgery, Erasmus MC-Sophia Children's Hospital, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands.
Insights
Palatal muscle repositioning (PMR) surgery for velopharyngeal insufficiency after cleft palate repair has the lowest incidence of obstructive sleep apnea (OSA). Pharyngeal flap procedures offer better speech outcomes but carry a higher OSA risk.
Area of Science:
- Craniofacial Surgery
- Pediatric Otolaryngology
- Sleep Medicine
Background:
- Secondary velopharyngeal insufficiency (VPI) after cleft palate repair can lead to obstructive sleep apnea (OSA).
- Surgical techniques for secondary VPI vary, with ongoing debate regarding the optimal approach.
- Understanding the airway obstructive outcomes of different VPI surgeries is crucial for patient management.
Purpose of the Study:
- To systematically review the incidence of OSA following different surgical modalities for secondary VPI in patients with repaired cleft palate.
- To compare the airway obstructive outcomes and speech results of pharyngeal flap (PF), sphincter pharyngoplasty (SP), and palatal muscle repositioning (PMR) procedures.
Main Methods:
- A systematic review adhering to PRISMA guidelines was conducted.
- Searches were performed in Medline, EMBASE, Web of Science, Google Scholar, and Cochrane Library.
- Studies reporting OSA occurrence after VPI surgery in non-syndromic cleft palate patients were included.
Main Results:
- Twenty-eight articles were included in the review.
- Palatal muscle repositioning (PMR) showed the lowest incidence of postoperative OSA (3%), compared to sphincter pharyngoplasty (SP) (34%) and pharyngeal flap (PF) (29%).
- Pharyngeal flap procedures yielded the best speech outcomes in terms of hypernasality reduction.
Conclusions:
- Palatal muscle repositioning (PMR) is associated with fewer postoperative complications, including a lower risk of OSA, while providing satisfactory speech improvement.
- Pharyngeal flap (PF) procedures, though linked to a higher risk of OSA, appear more effective in reducing hypernasality.
Study Design:
Systematic review.
Objective:
Obstructive sleep apnea (OSA) is a possible complication following secondary velopharyngeal insufficiency surgery in patients with repaired cleft palate. Various surgical techniques are used to treat secondary velopharyngeal insufficiency after cleft palate repair, but the optimal procedure remains debatable. This review provides an overview of the incidence of airway obstructive outcomes related to different surgical modalities.
Methods:
A systematic search was performed on the 1st of February following the PRISMA guidelines and registered on PROSPERO (CRD42022299715). The following databases were reviewed: Medline, EMBASE, Web of Science, Google Scholar, and the Cochrane Library databases. Studies that included data on the occurrence of OSA following velopharyngeal surgery in children with a repaired non-syndromic cleft palate were included. Non-English articles and studies that included syndromic cleft palate patients were excluded.
Results:
Twenty-eight articles met the inclusion criteria. The surgical procedures are classified into three groups: pharyngeal flap procedure (PF), sphincter pharyngoplasty (SP), and palatal muscle repositioning (PMR). Incidence of post-operative OSA and symptoms of OSA were lowest after PMR compared to SP and PF (3%; 34%; 29%, respectively). Pharyngeal flap procedures resulted in the best speech outcomes.
Conclusions:
PMR results in fewer postoperative complications in terms of OSA and achieves a satisfactory reduction in hypernasal speech. PF procedure carries a higher risk of developing OSA postoperatively but seems to be superior in the reduction in hypernasality.
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