ABSTRACT
PURPOSE: Obstructive sleep apnea is a major complication of pharyngeal flap surgery. The purpose of the present study is to predict preoperatively the risk of upper airway obstruction after surgery. MATERIAL AND METHODS: We performed an overnight sleep study preoperatively and postoperatively in 16 pediatric patients considered for pharyngeal flap surgery. Preoperative sleep study was done for two nights, once in normal breathing condition and once with complete nasal occlusion by packing of nostril with tampon gauze. RESULTS: In preoperative sleep recordings in normal breathing condition, all subjects had a normal apnea hypopnea index (AHI) less than 5/h. In preoperative recording with complete nasal occlusion, five patients exceeded 5/h in AHI. In particular, for two patients who had AHI higher than 15/h, we gave up a surgery in one case and performed pharyngeal flap operation for the other following a tracheotomy for severe disturbance of oral breathing. The remaining 14 subjects underwent surgery without airway obstructive complications. There was strong correlation between preoperative AHI with nasal tampon gauze and AHI at two weeks postoperatively (r = 0.88 P < .0001). There was no significant correlation between preoperative AHI in normal breathing condition and postoperative AHI (P > .05). CONCLUSIONS: These results exhibit preoperative sleep study with complete nasal airway occlusion represent postoperative breathing condition well during early postoperative period. Preoperative sleep study with complete nasal airway occlusion with nasal tampons could be useful for predicting the risk of upper airway obstruction secondary to pharyngeal flap surgery.
Subject(s)
Nasal Obstruction/etiology , Otorhinolaryngologic Surgical Procedures/adverse effects , Pharynx/surgery , Sleep Apnea, Obstructive/surgery , Velopharyngeal Insufficiency/surgery , Child , Child, Preschool , Female , Humans , Male , Nasal Obstruction/diagnosis , Nasal Obstruction/surgery , Pierre Robin Syndrome/complications , Pierre Robin Syndrome/surgery , Sleep Apnea, Obstructive/diagnosis , Sleep Apnea, Obstructive/etiology , Treatment Outcome , Velopharyngeal Insufficiency/etiologyABSTRACT
Descending necrotizing mediastinitis occurs secondary to deep neck infection, and the primary focus of infection is mostly located in the tonsil, pharynx and carious tooth. DNM following acute epiglottitis is quite rare, with only one case reported. We treated an 84-year old female with an acute epiglottitis followed by DNM. She was successfully treated by drainages with cervical surgery combined with thoracotomy and cervical surgery.
