Skip to main content
AAO-HNSF 2024 Annual Meeting & OTO EXPO Main banner
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Back

Scientific Oral Presentations

Pediatric Otolaryngology

Session: Scientific Oral Presentations 5 - Pediatric Otolaryngology

Management and Outcomes of Postoperative Airway Obstruction in Patients After Tissue-Augmentation Palatoplasty

Monday, September 30, 2024
9:36 AM – 9:42 AM EDT
Location: MBCC, Art Deco 228AB
Disclosure(s):
Soukaina Eljamri, BA:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Pooja D. Reddy, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Amber D. Shaffer, PhD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Matthew D. Ford, MS, CCC-SLP:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Rachel L. Whelan, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Allison B. Tobey, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Noel Jabbour, MD, MS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Tissue augmentation palatoplasty (TAP) is a technique in cleft palate repair using buccal fat and/or myomucosal flaps. Despite anecdotal evidence of postoperative obstruction with TAP, its management remains unclear.

Methods: This is a retrospective case series of primary TAP patients at a tertiary academic center from 2017 to 2023. Patients with obstruction symptoms within 1 year of surgery were included. Fisher’s exact, Wilcoxon rank-sum, and Spearman rank correlation were used to investigate the relationship between TAP type, obstruction severity, and postoperative intervention and polysomnography findings (Obstructive Apnea and Hypopnea Index (OAHI), total Apnea and Hypopnea Index (AHI)), symptom resolution, length of stay, and ED visits for obstruction.

Results: In total, 129 patients were reviewed and 25 met criteria (52% female, 32% syndromic). Of these, 17 underwent surgical intervention for obstruction (68.0%): revision palatoplasty/flap revision (8/25, 35%), tonsillectomy and adenoidectomy (10/25, 40%), and adenoidectomy only (5/25, 20%). After, 11 were medically managed and 3 were observed without intervention. Post-TAP total and obstructive AHI were worse in those who underwent surgical intervention versus those who did not (median 9.5 vs 2.1, p = 0.047, and 6.4 vs 0.7, p = 0.02, respectively). Worse post-TAP AHI and OAHI were associated with male gender (p = 0.03; p = 0.046), longer inpatient stay after TAP (p = 0.01; p = 0.01), and more ED visits for obstruction (p = 0.03; p = 0.03) respectively. In 9 patients with paired comparisons, there was no difference in the magnitude of improvement in AHI or OAHI between surgical intervention and medical management. Resolution of symptoms within 1 year of initial obstruction was more common in patients with Pierre Robin Sequence (p = 0.04) and TAP with bilateral myomucosal flaps (p = 0.02), though these groups were not more likely to undergo surgical intervention.

Conclusions: Postoperative obstruction is an important consequence of TAP requiring effective management. Further research is needed to elucidate factors impacting symptom resolution and postoperative obstruction risk.

    Presenting Author(s)

  • Pooja D. Reddy, BS

    Medical Student
    University of Pittsburgh School of Medicine
    Pittsburgh, PA, United States

    Disclosure information not submitted.

    • Co-Author(s)

  • SE

    Soukaina Eljamri, BA

    Medical Student
    University of Pittsburgh School of Medicine
    Pittsburgh, PA, United States

    Disclosure information not submitted.

  • AS

    Amber D. Shaffer, PhD

    Research Assistant Professor
    UPMC Children's Hospital of Pittsburgh
    Pittsburgh, Pennsylvania, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • Matthew D. Ford, MS, CCC-SLP

    Speech Pathologist
    UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA
    Pittsburgh, PA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • Rachel L. Whelan, MD

    Assistant Professor, Department of Otolaryngology
    University of Pittsburgh
    PGH, PA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • Allison B. Tobey, MD

    Assistant Professor
    Children's Hospital of Pittsburgh
    Pittsburgh, PA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Senior Author(s)

  • Noel Jabbour, MD, MS

    Associate Professor of Otolaryngology
    University of Pittsburgh School of Medicine
    Pittsburgh, PA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.