Division of flap in cleft palate patients after posterior pharyngeal flap surgery

Abstract

To investigate the reasons of flap division in patients with posterior pharyngeal flap and the outcome of the flap division for treating secondary velopharyngeal insufficiency (VPI) and obstructive sleep apnea-hypopnea syndrome (OSAHS). Twenty patients who underwent flap division after posterior pharyngeal flap surgery were included in this study, including 11 incomplete cleft palate and 9 complete cleft palate). Nasal endoscopy and lateral cephalometric radiographs were performed for all the patients preoperatively. Speech recordings were made pre- and post-operatively. The respiratory status of patients who had OSAHS manifestations was monitored by polysomnography. Simple division of the flap was carried out in 14 cases, and additional pharyngoplasty combined the division of posterior pharyngeal flap was performed in six cases. The speech did not show significant improvement in 14 cases after posterior pharyngeal flap surgery but improved after flap division. Three cases got speech improvement, but developed the respiratory obstruction causing sleep apnea. After the division of flap, the respiratory status got improved. Three cases required orthognathic surgery under general anesthesia, which demanded the division of flap simultaneously. The speech did not change after the division. If OSAHS occurred or VPI remained after posterior pharyngeal flap surgery, the division of the flap or additional pharyngoplasty should be performed. It is suggested that the operation of the flap division be done six months after posterior pharyngeal flap surgery.