Author(s)
Niketna Vivek, BA
James D. Phillips, MD, BS
Ryan Belcher, MD, MPH
Shilin Zhao, PhD
Hannah G. Kay, MD
Kalpnaben Patel, CCRP
Affiliation(s)
Vanderbilt University School of Medicine;
Abstract:
Background: Velopharyngeal insufficiency (VPI) poses a challenge in communication, particularly in children, due to inadequate closure between the oral and nasal cavities. The pharyngeal flap procedure is a well-established surgical intervention for VPI. A controversial aspect of VPI management pertains to the temporal relationship between adenotonsillectomy (T&A) surgery and the pharyngeal flap surgery.
Hypothesis: The timing of T&A will not significantly affect OSA or sleep improvement outcomes.
Methods: A retrospective chart review was conducted on patients undergoing pharyngeal flap surgery between February 2, 2004, and December 13, 2016, at a tertiary pediatric referral center. The study evaluated demographics, comorbidities, obstructive sleep apnea (OSA), sleep-related outcomes, and the impact of the timing of tonsillectomy and adenoidectomy (T&A) and pharyngeal flap surgery. Statistical tests included Kruskal-Wallis, Pearson, and Wilcoxon tests.
Results: The study consisted of 103 participants. Among them, 68 underwent T&A before or simultaneously with the pharyngeal flap surgery, and 35 did not undergo T&A or had it after the flap surgery. Higher BMI was associated with worse sleep outcomes. The timing of T&A did not significantly affect OSA outcomes or speech improvement outcomes. However, patients without T&A or those with delayed T&A had more total speech surgeries and an increased need for additional sleep surgeries.
Discussion: Whether to perform a pharyngeal flap simultaneously with a T&A in patients with VPI remains a subject of debate within the medical community. Our study contributes to this ongoing discussion by demonstrating that T&A timing did not significantly impact immediate OSA or speech improvement outcomes but it played a role in long-term management and the potential need for additional surgeries. The choice between methods may ultimately depend on surgeon comfort and area of expertise. Additionally, higher BMI was linked to poorer sleep outcomes, emphasizing the importance of weight management in VPI treatment. Our study has its limitations. It is retrospective and we only conducted polysomnograms if patients reported symptoms, potentially missing patients who did not express complaints. We encourage future studies in which all patients undergoing pharyngeal flap surgery should undergo polysomnograms as part of their 6-month follow-up evaluation.