The impact of adenoid size on rate of revision sphincter pharyngoplasty.

OBJECTIVES/HYPOTHESIS: Determine the impact of adenoid size and prior adenoidectomy on outcomes of sphincter pharyngoplasty. STUDY DESIGN: Retrospective review. METHODS: Retrospective review of patients 18 years of age or younger, who underwent sphincter pharyngoplasty for velopharyngeal insufficiency (VPI) from 2007 to 2012. Nasal endoscopy and nasometry testing were administered pre- and postoperatively. Preoperative adenoid size was scored by two blinded otolaryngologists. Primary outcome measures were sphincter pharyngoplasty revision rate, achievement of normal resonance, and degree of improvement in nasometry scores. RESULTS: Eighty-six patients were included in this study. The overall rate of revision sphincter pharyngoplasty was 28%. Patients with mild adenoid hypertrophy underwent less revision surgery (14%) than patients with moderate to severe adenoid hypertrophy (38%, P = .046). Subgroup analysis was performed based on prior repair of cleft or submucous cleft palate and history of 22q11 microdeletion. Smaller adenoids were associated with lower surgical revision rates in patients who did not have a history of cleft palate or 22q11 microdeletion (P = .014 and .018, respectively). Adenoid size did not impact revision rates in patients with repaired cleft palates or those with 22q11 microdeletions. CONCLUSIONS: Smaller or absent adenoids are associated with lower rates of revision surgery after sphincter pharyngoplasty in children with VPI. Patients with VPI and bulky adenoids, who do not have a history of cleft palate or 22q11 microdeletion, should be considered for adenoidectomy prior to sphincter pharyngoplasty.

Postoperative management following sphincter pharyngoplasty.

OBJECTIVE: To evaluate postoperative airway-associated outcomes following sphincter pharyngoplasty. STUDY DESIGN: Case series with chart review. SETTING: Academic tertiary care medical center. SUBJECTS AND METHODS: Postoperative management of sphincter pharyngoplasty (SP) conventionally includes overnight observation to monitor for upper airway obstruction. To evaluate for postoperative airway-related outcomes, 36 patients who underwent SP between April 2003 and January 2009 were evaluated retrospectively. RESULTS: Mean patient age was 8.1 (SD 4.3) years. Mean follow-up was 6.5 (SD 10.7) months. Cleft palate (36.1%), velo-cardio-facial syndrome (22.2%), and post-adenoidectomy (16.7%) were the most common causes of velopharyngeal insufficiency. All patients underwent overnight observation postoperatively. Mean hospital stay was 1.2 (SD 0.5) days. Five patients remained inpatient two or three days owing to fever (2 patients), bleeding ear after concurrent otoplasty (1 patient), minimal oropharyngeal bleeding with spontaneous resolution (1 patient), and medication allergy (1 patient). No patient had a documented apneic event or desaturation below 95 percent. Although no desaturations were documented, four patients received supplemental oxygen: three for less than two hours, and one for 12 hours. All patients had adequate oral intake and pain control on oral medications prior to discharge; nine patients required one to three doses of intravenous narcotic medication for pain on postoperative day zero. CONCLUSION: Upper airway obstruction requiring overnight observation following SP is uncommon. In otherwise healthy patients, performing SP in an outpatient setting, given appropriate recovery room evaluation for airway concerns, oral intake, and pain control, should be considered.