Reddy Pooja D, Eljamri Soukaina, Shaffer Amber D, Ford Matthew, Whelan Rachel, Tobey Allison, Jabbour Noel
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Otolaryngol Head Neck Surg. 2025 Oct;173(4):1007-1013. doi: 10.1002/ohn.1319. Epub 2025 May 29.
To characterize postoperative airway obstruction and evaluate management strategies in pediatric patients with cleft palate following tissue-augmentation palatoplasty (TAP).
Retrospective case series.
Single academic center.
Patients with obstruction within 1 year of primary TAP between 2017 and 2023 were identified. Fisher's exact, Wilcoxon rank-sum, and Spearman rank correlation were used to investigate the relationship between TAP type, obstruction severity, interventions, and polysomnography (PSG) findings (Obstructive Apnea-Hypopnea Index [OAHI], total Apnea-Hypopnea Index [AHI]) and disposition details.
Of the 129 patients who underwent primary TAP, 25 patients developed obstructive symptoms (19.4%); 52% female, 32% syndromic. In total, 17 underwent surgical intervention for obstruction (68.0%): revision palatoplasty/flap revision (8/25, 35%), tonsillectomy and partial cephalic adenoidectomy (10/25, 40%), and partial cephalic adenoidectomy only (5/25, 20%). In total, 11 were medically managed and 3 were observed without intervention. In nine patients with paired PSGs, there was no difference in pre-TAP and post-TAP AHI or OAHI. Patients who underwent surgical revision had worse pre-TAP AHI compared to those who did not undergo surgical revision (mean ± SD: 15.7 ± 5.9 vs 6.2 ± 4.1, P = .01).
TAP is a newer surgical technique used to address tissue deficiency in cleft palate repair. Most patients who experienced postoperative obstruction following TAP ultimately required surgical intervention, though preoperative AHI may help identify those at higher risk for obstruction. Future studies are necessary to evaluate the efficacy of earlier interventions and elucidate factors impacting obstruction risk and symptom resolution.
描述组织增强腭成形术（TAP）后小儿腭裂患者的术后气道阻塞情况，并评估管理策略。
回顾性病例系列研究。
单一学术中心。
确定2017年至2023年间初次TAP术后1年内出现阻塞的患者。采用Fisher精确检验、Wilcoxon秩和检验和Spearman秩相关分析来研究TAP类型、阻塞严重程度、干预措施与多导睡眠图（PSG）结果（阻塞性呼吸暂停低通气指数[OAHI]、总呼吸暂停低通气指数[AHI]）以及处置细节之间的关系。
在129例行初次TAP的患者中，25例出现阻塞症状（19.4%）；女性占52%，综合征性占32%。共有17例因阻塞接受了手术干预（68.0%）：腭成形术修复/皮瓣修复（8/25，35%）、扁桃体切除术和部分头部腺样体切除术（10/25，40%）以及仅行部分头部腺样体切除术（5/25，20%）。共有11例接受了药物治疗，3例未干预仅观察。在9例有配对PSG的患者中，TAP术前和术后的AHI或OAHI无差异。接受手术修复的患者术前AHI比未接受手术修复的患者更差（均值±标准差：15.7±5.9对6.2±4.1，P = 0.01）。
TAP是一种用于解决腭裂修复中组织缺损的较新手术技术。大多数TAP术后出现阻塞的患者最终需要手术干预，尽管术前AHI可能有助于识别阻塞风险较高的患者。未来有必要开展研究以评估早期干预的疗效，并阐明影响阻塞风险和症状缓解的因素。
