Reath D B, LaRossa D, Randall P
Division of Plastic Surgery, University of Pennsylvania School of Medicine, Philadelphia.
Cleft Palate J. 1987 Jul;24(3):250-3.
Posterior pharyngeal flap (PPF) construction in patients with hypertrophied tonsils raises a significant concern for adequate airway maintenance. Most often, tonsillectomy, as a separate procedure, is done first. The authors have preferred to do both the PPF and the tonsillectomy simultaneously. Twenty consecutive cases are reviewed retrospectively to determine whether this has increased morbidity. All patients underwent posterior pharyngeal flaps for correction of velopharyngeal incompetence (VPI). Postoperative fevers that resolved without specific treatment occurred in four patients. Three patients experienced postoperative bleeding problems, but only two were of tonsillar origin. No patient developed immediate airway obstruction, although a single patient was observed overnight in the intensive care unit. Another developed sleep apnea several months after the operation, which required that the posterior pharyngeal flap be taken down. This patient had an unusual amount of hypertrophic scar in the nasopharyngeal area, but not in the oropharynx. No other operative or postoperative complications were experienced. The average hospitalization was 4.2 days. It is concluded that simultaneous tonsillectomy and PPF construction may be performed safely in patients who need both procedures.
对于扁桃体肥大的患者，进行咽后瓣（PPF）手术时，气道能否充分维持是一个重大问题。通常，扁桃体切除术会作为一个单独的手术首先进行。而作者更倾向于同时进行PPF手术和扁桃体切除术。回顾性分析连续20例病例，以确定这种做法是否增加了发病率。所有患者均接受了咽后瓣手术以纠正腭咽闭合不全（VPI）。4例患者术后出现未经特殊治疗即自行消退的发热。3例患者出现术后出血问题，但只有2例出血源于扁桃体。尽管有1例患者在重症监护病房过夜观察，但没有患者出现即刻气道梗阻。另1例患者术后数月出现睡眠呼吸暂停，这需要拆除咽后瓣。该患者鼻咽部有异常大量的肥厚性瘢痕，但口咽部没有。未出现其他手术或术后并发症。平均住院时间为4.2天。结论是，对于同时需要这两种手术的患者，可以安全地同时进行扁桃体切除术和PPF手术。
