Surgical Management of Airway Obstruction following Posterior Pharyngeal Flap

Background:The posterior pharyngeal flap (PPF) is effective in managing velopharyngeal insufficiency but is associated with airway obstruction risk. This study compared the effectiveness and complications of 2 PPF revision procedures and screened potential prognostic factors to postoperative hypernasality and persistent obstruction.Methods:Patients who received flap division (FD) or port enlargement (PE) for airway obstruction following PPF were reviewed. Ventilation status was assessed using the Nasal Obstruction Symptom Evaluation scale, and velopharyngeal closure was assessed using subjective speech evaluation and nasopharyngoscopy. The effectiveness of ventilation relief and complication rate (hypernasality and persistent obstruction) of the 2 techniques were compared. A comprehensive panel of factors-including age, velopharyngeal mobility, obstruction laterality, body mass index, jaw relationship, and adenoid hypertrophy-was evaluated for correlation with complications.Results:A total of 79 patients were enrolled, with 51 undergoing FD and 28 undergoing PE. Both techniques significantly improved ventilation dysfunction and hyponasality. Mild hypernasality occurred in 10 cases in the FD group and 3 in the PE group. Age at surgery was significantly associated with persistent obstruction after PPF revision. The occurrence of persistent obstruction was significantly higher among patients younger than 12 years than those older than 12 years. Obstruction laterality was suggested in significant correlation with hypernasality after PPF revision. Among patients with unilateral port obstruction, the occurrence of hypernasality after FD was significantly higher than after PE.Conclusions:Both flap division and port enlargement are effective revision procedures to relieve airway obstruction after PPF. Patients younger than 12 years are more likely to experience persistent ventilation problems after PPF revision.CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, II.