State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Dept. of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
Hua Xi Kou Qiang Yi Xue Za Zhi. 2024 Dec 1;42(6):755-763. doi: 10.7518/hxkq.2024.2024218.
Flap division is the primary method for treating postoperative airway obstruction following pharyngeal flap surgery. However, a discussion on the treatment effectiveness and prognosis of this surgery is lacking. Therefore, this study aims to explore the effectiveness of flap division in improving airway obstruction and hyponasality after pharyngoplasty and to analyze the risk factors for postoperative complications.
A retrospective review was conducted on the data of all patients who underwent flap division following pharyngeal flap for airway obstruction at our institution. Pre- and post-operative assessments of ventilation, speech, and related factors were performed using the nasal obstruction symptom evaluation scale, speech evaluation scale, nasopharyngeal fiberscope, and lateral cephalometric radiographs. A nasopharyngeal fiberscope was utilized to observe the airway port of the patients, velopharyngeal closure, and the mobility of the lateral pharyngeal walls. Lateral cephalometric radiographs were employed to evaluate the patient's maxillomandibular relationship and adenoid dimensions. A logistic regression model incorporating univariate analysis and multivariate analyses was established to identify the prognostic factors influencing the occurrence of persistent postoperative airway obstruction and hypernasality.
Among the 63 patients, 56 patients (88.9%) experienced a reduction in the severity of airway obstruction postoperatively but 20 patients (31.7%) still presented with moderate-to-severe airway obstruction. Age at surgery (=0.023) and adenoid hypertrophy (=0.003) were significantly associated with persistent postoperative airway obstruction. All 39 individuals exhibiting preoperative hyponasality demonstrated effective resolution after flap division, and 11 patients (17.5%) experienced mild hypernasality postoperatively. Unilateral port obstruction (=0.004) and BMI (=0.027) were identified as potential independent factors influencing the development of postoperative hypernasality.
Flap division is an effective measure for improving postoperative airway obstruction and hyponasality following pharyngeal flap, although some patients may continue to experience persistent airway obstruction and develop hypernasality after division. Age at surgery and adenoid hypertrophy are prognostic factors for persistent airway obstruction following flap division. Unilateral/bilateral nasal airway obstruction and BMI are related factors for post-operative hypernasality.
皮瓣切开术是治疗咽成形术后气道阻塞的主要方法。然而，对于这种手术的治疗效果和预后的讨论还很缺乏。因此，本研究旨在探讨皮瓣切开术改善咽成形术后气道阻塞和鼻音低下的效果，并分析术后并发症的危险因素。
回顾性分析在我院因气道阻塞而行咽成形术后行皮瓣切开术的所有患者的数据。采用鼻阻塞症状评估量表、语音评估量表、鼻咽纤维镜和侧位头颅侧位片对通气、语音及相关因素进行术前和术后评估。使用鼻咽纤维镜观察患者的气道口、咽腔闭合和外侧咽壁的活动度。侧位头颅侧位片用于评估患者的上下颌骨关系和腺样体大小。采用单因素分析和多因素分析建立逻辑回归模型，以确定影响持续性术后气道阻塞和高鼻音发生的预后因素。
在 63 例患者中，56 例（88.9%）术后气道阻塞严重程度减轻，但仍有 20 例（31.7%）存在中重度气道阻塞。手术时的年龄（=0.023）和腺样体肥大（=0.003）与持续性术后气道阻塞显著相关。所有术前存在低鼻音的 39 例患者经皮瓣切开术后均有效缓解，11 例（17.5%）术后出现轻度高鼻音。单侧气道口阻塞（=0.004）和 BMI（=0.027）被确定为影响术后高鼻音发展的独立危险因素。
皮瓣切开术是改善咽成形术后气道阻塞和低鼻音的有效措施，但部分患者术后仍存在持续性气道阻塞和高鼻音。手术时的年龄和腺样体肥大是皮瓣切开术后持续性气道阻塞的预后因素。单侧/双侧鼻气道阻塞和 BMI 是术后高鼻音的相关因素。
