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Airway Compromise Following Cleft Palate Repair in Robin Sequence: Improving Safety and Predictability
Melinda Costa, MD; Kariuki Murage, MD; Sunil Tholpady, MD, PhD; Roberto Flores, MD
Indiana University
2014-03-01
Presenter: Melinda Costa
Affidavit:
This submission represents the original work of the authors. The presenting fellow has made primary contribution to the design, data analysis, and editing of the study.
Director Name: Robert L. Flores, MD
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Purpose:
Many studies report a high incidence of airway complications in patients with Robin sequence (RS) following palate repair. Our institution utilizes polysomnography (PSG) to assess risk of airway compromise prior to palatoplasty in these patients. The purpose of this study is to compare airway complications after palatoplasty in RS to cleft palate only (CPO) using the screening airway protocol. In addition, we identify risk factors for airway complications after palatoplasty.
Methods:
A 12-year retrospective review of patients with RS undergoing palatoplasty was performed. RS patients were divided into non-operative (RS-Nonop) or mandibular distraction osteogenesis (RS-MDO) treatment groups. Patients with Veau I and II cleft palate only (CPO) served as matched controls. Preoperative variables included comorbidities and apnea hypopnea index (AHI). Airway complications were defined as reintubation, emergency room (ER) visit, or readmission within 3 months of palatoplasty. Significant variables for postoperative airway complications were identified via univariate analysis.
Results:
113 patients met inclusion criteria: 34.5% CPO, 65.5% RS, and 30.1% RS-MDO. Mean follow up was 18 months. The total airway complication rate was 7.1%; this was similar between RS (6.8%) and CPO (7.7%). In isolated RS, the reintubation rate was 0%. Significant variables for reintubation for all patients were cardiac anomalies (p=0.046), gastrointestinal anomalies (p=0.04), lower airway anomalies (p=0.02); syndromic diagnosis trended towards significance (p=0.05).
Conclusions:
In patients with RS, screening PSG can minimize airway complications following palatoplasty to a rate comparable to patients with CPO. Cardiac, gastrointestinal, and lower airway anomalies are associated with postoperative reintubation.
