Two hundred twenty-two consecutive pharyngeal flaps: An analysis of postoperative complications

Purpose: The most frequent surgical technique used to treat velopharyngeal insufficiency (VPI), the pharyngeal flap is also one of the more dangerous pediatric procedures due to the potential for airway obstruction and patient death. Prompted by recent concerns over high complication rates associated with this procedure, we completed a retrospective cohort study to evaluate the incidence and character of postoperative complications after 222 consecutive pharyngeal flap surgeries. Materials and Methods: A database review was undertaken of all pharyngeal flap surgeries completed from January 2000 to April 2006 at a tertiary pediatric craniofacial center. Main outcome measures included postoperative complications, such as airway compromise manifested as oxygen desaturation, hemorrhage requiring reoperation, wound infection, pharyngeal flap breakdown, and development of obstructive sleep apnea. Results: In 222 consecutive pharyngeal flap patients, the mean age at surgery was 6.4 years (range, 3.1 to 17 years). Postoperative complications were rare in this cohort. Twelve patients (8.0%) required supplemental oxygenation for limited desaturation, and 3 patients (1.35%) demonstrated significant postoperative bleeding. Five patients (3.33%) demonstrated positive findings of OSA at 6 months or longer after postpharyngeal flap surgery. Conclusion: When coupled with a thorough preoperative evaluation by specialized personnel, pharyngeal flap surgery is a safe and reliable option for the surgical management of VPI. (C) 2008 American Association of Oral and Maxillofacial Surgeons.