Severe Obstructive Sleep Apnea After Pharyngeal Fat Injection for Velopharyngeal Insufficiency

Area of Science:

• Pediatric Surgery
• Otolaryngology
• Genetics

Background:

• Cleft lip and palate repair is a common surgical procedure in infants.
• Obstructive sleep apnea (OSA) is a known complication following palatoplasty.
• Chromosomal deletions, such as 8p11.23, can present with complex airway challenges.

Observation:

• A 3-month-old male with 8p11.23 deletion underwent cleft repair, initially showing mild OSA.
• Subsequent interventions for hypernasality included autologous fat injection to the posterior pharyngeal wall.
• This led to the development of severe OSA (AHI 59.5) due to a large lipomatous mass impinging on the airway.

Findings:

• Excision of the extensive lipomatous mass was necessary to alleviate airway obstruction.
• Post-excision, the patient's mother reported improvement in snoring, though formal follow-up is pending.
• This case highlights a significant, albeit uncommon, postoperative complication of pharyngeal fat augmentation.

Implications:

• Surgeons performing pharyngeal procedures, especially with autologous fat grafts, must be aware of the potential for delayed airway compromise.
• Careful patient selection and meticulous surgical technique are crucial to minimize risks.
• Further research into the long-term outcomes and management strategies for such complications is warranted.