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Post-operative respiratory distress following primary cleft palate repair

  • D Smith (a1), S E F H J Abdullah (a1), A Moores (a2) and D M Wynne (a3)



Infants are obligate nasal breathers. Cleft palate closure may result in upper airway compromise. We describe children undergoing corrective palatal surgery who required unplanned airway support.


Tertiary referral unit.


Retrospective study (2007–2009) of 157 cleft palate procedures (70 primary procedures) in 43 patients. Exclusion criteria comprised combined cleft lip and palate, secondary palate procedure, and pre-existing airway support.


The children's mean age was 7.5 months and their mean weight 7.72 kg. Eight children were syndromic, and eight underwent pre-operative sleep studies (five positive, three negative). Post-operatively, five developed respiratory distress and four required oxygen, both events significantly associated with pre-operative obstructive sleep apnoea (p = 0.001 and 0.015, respectively). Four desaturated within 24 hours. Five required a nasopharyngeal airway. Hospital stay (mean, 4 days) was significantly associated with obstructive sleep apnoea (p = 0.002) and nasopharyngeal airway insertion (p = 0.017).


Pre-operative obstructive sleep apnoea correlated significantly with post-operative respiratory distress, supplementary oxygen requirement, nasopharyngeal airway insertion and hospital stay. We recommend pre-operative sleep investigations for all children undergoing cleft palate repair, to enable appropriate timing of the procedure.


Corresponding author

Address for correspondence: Mr David M Wynne, Department of ENT Surgery, Royal Hospital for Sick Children, Yorkhill Hospitals, Glasgow G3 8SJ, Scotland, UK Fax: +44(0)141 201 0865 E-mail:


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Presented as a poster at the 10th Congress of the European Society for Pediatric Otorhinolaryngology, 5–8 June 2010, Pamplona, Spain



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8 Denk, MJ, Magee, WP. Cleft palate closure in the neonate preliminary report. Cleft Palate Craniofac J 1995;33:5766
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The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
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