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Safety of nasal stenting in pharyngeal flap surgery for pediatric velopharyngeal dysfunction.

Abstract

INTRODUCTION

The pharyngeal flap procedure is an effective surgery for velopharyngeal dysfunction (VPD) yet carries approximately a 3.2% post-operative airway obstruction risk. Life threatening airway compromise occurs in first 24 h post-operatively. Nasopharyngeal airway has been shown to decrease these complications but its routine use is not commonplace. At our centre, surgical technique involves routine placement of bilateral nasopharyngeal airway referred to as nasal stenting. Our objective was to demonstrate safety of nasal stenting for children with VPD undergoing pharyngeal flap surgery.

METHODS

A retrospective review of pediatric patients aged 1 through 18 years at the time of VPD diagnosis, who underwent superiorly based pharyngeal flap surgery at London Health Sciences Centre (LHSC), was conducted. Patients were admitted to a regular ward with bihourly oxygen saturation checks. Nasal stents were removed on post-operative day two. Demographic data along with patient outcomes and perioperative complications were collected and analyzed.

RESULTS

Eighty-five pediatric patients underwent superiorly based pharyngeal flap surgery at LHSC from November 2004 through February 2017 that met inclusion criteria. Mean age at the time of surgery was 11.0 years, whereas average age at diagnosis was 8.7 years. The majority of patients (60.0%) had history of cleft palate repair. Only 28.2% had additional comorbidities, the most common being Pierre-Robin Sequence. Average length of hospital stay was 2.7 days. No patients required admission to an intensive care unit. Surgical complication rate was 8.2%. No post-operative airway obstruction events were encountered. Two patients (2.3%) underwent pharyngeal flap reversal for obstructive sleep apnea and one for persistent nasal obstruction. Five (5.9%) minor stent-related complications were captured. Two patients developed self-limiting epistaxis. Two patients had partially extruded stents prior to their removal. One patient developed nasopharyngeal port granuloma which resolved with a course of intranasal corticosteroids.

CONCLUSION

Nasal stenting for pharyngeal flap surgery is safe. Stent related complications were minor and did not influence length of hospital stay. A prospective study to determine if routine stenting would lead to decreased serious airway complications is warranted.

Authors+Show Affiliations

Department of Otolaryngology-Head and Neck Surgery, Western University, Canada.Department of Otolaryngology-Head and Neck Surgery, Western University, Canada.Department of Otolaryngology-Head and Neck Surgery, Western University, Canada.Department of Otolaryngology-Head and Neck Surgery, Western University, Canada. Electronic address: murad.husein@lhsc.on.ca.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31794903

Citation

Araslanova, R, et al. "Safety of Nasal Stenting in Pharyngeal Flap Surgery for Pediatric Velopharyngeal Dysfunction." International Journal of Pediatric Otorhinolaryngology, vol. 130, 2019, p. 109804.
Araslanova R, Instrum R, Dzioba A, et al. Safety of nasal stenting in pharyngeal flap surgery for pediatric velopharyngeal dysfunction. Int J Pediatr Otorhinolaryngol. 2019;130:109804.
Araslanova, R., Instrum, R., Dzioba, A., & Husein, M. (2019). Safety of nasal stenting in pharyngeal flap surgery for pediatric velopharyngeal dysfunction. International Journal of Pediatric Otorhinolaryngology, 130, p. 109804. doi:10.1016/j.ijporl.2019.109804.
Araslanova R, et al. Safety of Nasal Stenting in Pharyngeal Flap Surgery for Pediatric Velopharyngeal Dysfunction. Int J Pediatr Otorhinolaryngol. 2019 Nov 28;130:109804. PubMed PMID: 31794903.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Safety of nasal stenting in pharyngeal flap surgery for pediatric velopharyngeal dysfunction. AU - Araslanova,R, AU - Instrum,R, AU - Dzioba,A, AU - Husein,M, Y1 - 2019/11/28/ PY - 2019/09/25/received PY - 2019/11/05/revised PY - 2019/11/25/accepted PY - 2019/12/4/pubmed PY - 2019/12/4/medline PY - 2019/12/4/entrez KW - Cleft palate KW - Nasal stents KW - Nasopharyngeal airway KW - Pharyngeal flap KW - Velopharyngeal dysfunction SP - 109804 EP - 109804 JF - International journal of pediatric otorhinolaryngology JO - Int. J. Pediatr. Otorhinolaryngol. VL - 130 N2 - INTRODUCTION: The pharyngeal flap procedure is an effective surgery for velopharyngeal dysfunction (VPD) yet carries approximately a 3.2% post-operative airway obstruction risk. Life threatening airway compromise occurs in first 24 h post-operatively. Nasopharyngeal airway has been shown to decrease these complications but its routine use is not commonplace. At our centre, surgical technique involves routine placement of bilateral nasopharyngeal airway referred to as nasal stenting. Our objective was to demonstrate safety of nasal stenting for children with VPD undergoing pharyngeal flap surgery. METHODS: A retrospective review of pediatric patients aged 1 through 18 years at the time of VPD diagnosis, who underwent superiorly based pharyngeal flap surgery at London Health Sciences Centre (LHSC), was conducted. Patients were admitted to a regular ward with bihourly oxygen saturation checks. Nasal stents were removed on post-operative day two. Demographic data along with patient outcomes and perioperative complications were collected and analyzed. RESULTS: Eighty-five pediatric patients underwent superiorly based pharyngeal flap surgery at LHSC from November 2004 through February 2017 that met inclusion criteria. Mean age at the time of surgery was 11.0 years, whereas average age at diagnosis was 8.7 years. The majority of patients (60.0%) had history of cleft palate repair. Only 28.2% had additional comorbidities, the most common being Pierre-Robin Sequence. Average length of hospital stay was 2.7 days. No patients required admission to an intensive care unit. Surgical complication rate was 8.2%. No post-operative airway obstruction events were encountered. Two patients (2.3%) underwent pharyngeal flap reversal for obstructive sleep apnea and one for persistent nasal obstruction. Five (5.9%) minor stent-related complications were captured. Two patients developed self-limiting epistaxis. Two patients had partially extruded stents prior to their removal. One patient developed nasopharyngeal port granuloma which resolved with a course of intranasal corticosteroids. CONCLUSION: Nasal stenting for pharyngeal flap surgery is safe. Stent related complications were minor and did not influence length of hospital stay. A prospective study to determine if routine stenting would lead to decreased serious airway complications is warranted. SN - 1872-8464 UR - https://www.unboundmedicine.com/medline/citation/31794903/Safety_of_nasal_stenting_in_pharyngeal_flap_surgery_for_pediatric_velopharyngeal_dysfunction L2 - https://linkinghub.elsevier.com/retrieve/pii/S0165-5876(19)30557-9 DB - PRIME DP - Unbound Medicine ER -