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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)

Abstract

Introduction:

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.

Setting:

Tertiary referral unit.

Method:

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.

Results:

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).

Discussion:

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.

Copyright

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: david.wynne@nhs.net

Footnotes

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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

Footnotes

References

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1 Bellis, TH, Wohlgemuth, B. The incidence of cleft lip and palate deformities in the south east of Scotland (1971–1990). Br J Orthod 1999;26:121–5
2 Clinical Standards Advisory Group. Cleft Lip and/or Palate: Report of a CSAG Committee. London: Stationery Office, 1998
3 Rohrich, RJ, Love, EJ, Byrd, S, Johns, D. Optimal timing of cleft palate. Plast Reconstr Surg 2000;106:423–5
4 Levison, J, Neas, K, Wilson, M, Cooper, P, Wojtulewicz, J. Neonatal nasal obstruction and a single maxillary central incisor. J Paediatr Child Health 2005;41:380–1
5 Moore, MD, Lawrence, WT, Ptak, JJ, Tier, WC. Complications of primary palatoplasty: a twenty-one year review. Cleft Palate J 1988;25:156–62
6 Orr, WC, Levine, NS, Buchanan, RT. Effect of cleft palate repair and pharyngeal flap surgery on upper airway obstruction during sleep. Plast Reconstr Surg 1987;80:226–32
7 Antony, AK, Sloan, GM. Airway obstruction following palatoplasty: analysis of 247 consecutive operations. Cleft Palate Craniofac J 2002;39:145–8
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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