Management and Outcomes of Postoperative Airway Obstruction in Patients After Tissue-Augmentation Palatoplasty

To characterize postoperative airway obstruction and evaluate management strategies in pediatric patients with cleft palate following tissue-augmentation palatoplasty (TAP).

Retrospective case series.

Single academic center.

Patients with obstruction within 1 year of primary TAP between 2017 and 2023 were identified. Fisher's exact, Wilcoxon rank-sum, and Spearman rank correlation were used to investigate the relationship between TAP type, obstruction severity, interventions, and polysomnography (PSG) findings (Obstructive Apnea-Hypopnea Index [OAHI], total Apnea-Hypopnea Index [AHI]) and disposition details.

Of the 129 patients who underwent primary TAP, 25 patients developed obstructive symptoms (19.4%); 52% female, 32% syndromic. In total, 17 underwent surgical intervention for obstruction (68.0%): revision palatoplasty/flap revision (8/25, 35%), tonsillectomy and partial cephalic adenoidectomy (10/25, 40%), and partial cephalic adenoidectomy only (5/25, 20%). In total, 11 were medically managed and 3 were observed without intervention. In nine patients with paired PSGs, there was no difference in pre-TAP and post-TAP AHI or OAHI. Patients who underwent surgical revision had worse pre-TAP AHI compared to those who did not undergo surgical revision (mean ± SD: 15.7 ± 5.9 vs 6.2 ± 4.1, P = .01).

TAP is a newer surgical technique used to address tissue deficiency in cleft palate repair. Most patients who experienced postoperative obstruction following TAP ultimately required surgical intervention, though preoperative AHI may help identify those at higher risk for obstruction. Future studies are necessary to evaluate the efficacy of earlier interventions and elucidate factors impacting obstruction risk and symptom resolution.