Audiology - Communication Research E-ISSN: 2317-6431 [email protected] Academia Brasileira de Audiologia Brasil Fukushiro, Ana Paula; Domingues Zwicker, Carmen Vivian; Flores Genaro, Katia; Paciello Yamashita, Renata; Kiemle Trindade, Inge Elly Nasopharyngeal dimensions and respiratory symptoms after pharyngeal flap surgery in children and adults Audiology - Communication Research, vol. 18, núm. 2, abril-junio, 2013, pp. 57-62 Academia Brasileira de Audiologia São Paulo, Brasil Available in: http://www.redalyc.org/articulo.oa?id=391544054002 How to cite Complete issue Scientific Information System More information about this article Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Journal's homepage in redalyc.org Non-profit academic project, developed under the open access initiative Original Article Nasopharyngeal dimensions and respiratory symptoms after pharyngeal flap surgery in children and adults Dimensões nasofaríngeas e sintomas respiratórios após a cirurgia de retalho faríngeo em crianças e adultos Ana Paula Fukushiro1, Carmen Vivian Domingues Zwicker2, Katia Flores Genaro1, Renata Paciello Yamashita1, Inge Elly Kiemle Trindade1 ABSTRACT RESUMO Purpose: To investigate the influence of age on nasopharyngeal di- Objetivo: Verificar a influência da idade sobre as dimensões nasofarín- mensions and respiratory symptoms in patients undergoing surgery to geas e os sintomas respiratórios em pacientes submetidos à cirurgia para correct velopharyngeal insufficiency using the pharyngeal flap tech- a correção da insuficiência velofaríngea pela técnica de retalho faríngeo. nique. Methods: A sample comprising 103 individuals divided into Métodos: Amostra formada por 103 indivíduos distribuídos em três three groups: children (6-12 years old), young adults (18-30 years old) grupos: crianças (6 a 12 anos), adultos jovens (18 a 30 anos) e adultos de and middle-aged adults (≥ 40 years old). This was a retrospective study meia-idade (≥40 anos). Trata-se de estudo retrospectivo que analisou os that analyzed the values ​​for the nasopharyngeal area (pressure-flow valores da área nasofaríngea (técnica fluxo-pressão, valor de referência technique, reference value: 0.570 cm2) and the symptoms of oral respi- 0,570 cm2) e os sintomas de respiração oral, ronco e dificuldade respira- ration, snoring and respiratory difficulties during sleep. The values were tória durante sono, obtidos, em média, 12 meses após a cirurgia. A área obtained, on average, 12 months after surgery. The nasopharyngeal area nasofaríngea foi comparada entre os grupos por análise de variância e os was compared between the groups using analysis of variance, and res- sintomas respiratórios pelo teste Qui-quadrado (p<0,05). Resultados: Os piratory symptoms were compared using the chi-squared test (p<0.05). valores médios da área nasofaríngea após a cirurgia foram 0,527±0,215 Results: The mean nasopharyngeal area values after surgery were cm2, 0,599±0,213 cm2 e 0,488±0,276 cm2, respectivamente para crianças, 0.527±0.215 cm2, 0.599±0.213 cm2 and 0.488±0.276 cm2 for children, adultos jovens e adultos de meia-idade, não havendo diferença entre os young adults and middle-aged adults, respectively, with no differences grupos. As proporções de respiração oral, ronco e dificuldade respiratória between groups. The proportions of oral respiration, snoring and brea- durante o sono foram, respectivamente, 66%, 69% e 9% nas crianças, thing difficulty during sleep were, respectively, 66%, 69% and 9% in 51%, 49% e 7% nos adultos jovens e 75%, 75% e 19% nos adultos de children; 51%, 49% and 7% in young adults; and 75%, 75% and 19% in meia-idade, com maior frequência de ronco nos adultos de meia-idade. middle-aged adults, with a higher frequency of snoring in middle-aged Conclusão: A idade não interferiu nas dimensões nasofaríngeas na adults. Conclusion: Age did not affect nasopharyngeal dimensions in presença de retalho faríngeo, mas foi um fator agravante de sintomas the presence of a pharyngeal flap, but it was an aggravating factor for respiratórios, principalmente nos indivíduos mais velhos. respiratory symptoms, especially in older individuals. Descritores: Fissura palatina; Insuficiência velofaríngea; Cirurgia bucal; Keywords: Cleft palate; Velopharyngeal insufficiency; Surgery, oral; Sinais e sintomas respiratórios; Rinomanometria Signs and symptoms, Respiratory; Rhinomanometry Work developed in the Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, Universidade de São Paulo – USP – São Paulo (SP), Brazil. (1) Graduate Program in Rehabilitation Sciences, Hospital for Rehabilitation of Craniofacial Anomalies, Universidade de São Paulo – USP – São Paulo (SP), Brazil. (2) Graduate Program (Master) in Rehabilitation Sciences, Hospital for Rehabilitation of Craniofacial Anomalies, Universidade de São Paulo – USP – São Paulo (SP), Brazil. Conflicts of interest:No Author´s contributions: APF: lead author, participation in the original study idea, data collection, data analysis and the writing of the article; CVDZ: participa- tion in statistical data analysis and the writing of the results; KFG: participation in the statistical analysis and the writing of the article; RPY: participation in data collection and the writing of the article; and IEK: research group leader, participation in the original study idea and the writing of the article. Correspondence address: Ana Paula Fukushiro. R. Sílvio Marchione, 3/20, Vila Universitária, Bauru (SP), Brazil, CEP: 17012-900. E-mail: [email protected] Received: 4/25/2012; Accepted: 6/5/2013 ACR 2013;18(2):57-62 57 Fukushiro AP, Zwicker CVD, Genaro KF, Yamashita RP, Trindade IEK INTRODUCTION In studying sleep-disordered breathing in middle-aged adults who had undergone surgery to correct VPI using a Cleft lip/palate is a congenital deformity that can manifest pharyngeal flap, one study reported oral respiration, snoring in the lip, palate or both structures. Reconstructive surgery is re- and episodes of respiratory obstruction in 53% of cases, quired to correct this abnormality. Cheiloplasty and palatoplasty confirming that the pharyngeal flap can contribute to the are the first surgeries performed during the long and complex worsening of respiratory disorders in this age group(19). In treatments which, in conjunction with other therapeutic appro- young adults, the effect of the pharyngeal flap on the nasal aches, are critical for patient rehabilitation(1). and nasopharyngeal dimensions was investigated and corre- A cleft palate is considered the most frequent cause of lated with respiratory complaints, showing the emergence or velopharyngeal insufficiency (VPI), a structural change in the worsening of these complaints in 55% of cases in the short velopharyngeal mechanism. The most common symptom of term and 36% in the long term. In an aerodynamic evaluation, VPI is hypernasality, which is associated with nasal air emission a more pronounced decrease in nasopharyngeal dimensions and low intraoral air pressure(2-4). was observed in patients who only reported respiratory com- It is generally agreed that palatoplasty should have the plaints after surgery, highlighting the importance of moni- functional purpose of improving conditions for the velum to toring surgical results using objective measures(14). Another help the velopharyngeal mechanism. However, in many cases, study involving children analyzed respiratory symptoms and even after primary corrective surgery, VPI symptoms persist, investigated the surgical complications of the pharyngeal requiring a secondary procedure(5,6). Surgery using the supe- flap, identifying oxygen desaturation in 8% of the sample riorly based pharyngeal flap technique is one of the methods and positive findings of obstructive sleep apnea in 3% six most frequently employed to correct VPI. The technique con- months after surgery(20). sists of building a bridge of myomucosal tissue between the In terms of VPI correction, surgery should be performed as velum and the posterior pharyngeal wall, bounded by two side soon as there is good nasal patency. However, the effects of the orifices that allow nasal breathing. The purpose of the flap is pharyngeal flap technique on respiration and the technique’s to create a mechanical obstruction to the airflow to eliminate correlation with velopharyngeal orifice dimensions in different hypernasality and nasal air emission, with increased intraoral age groups is a subject that has been minimally explored to date. pressure(7) during speech production. In addition, one must consider that respiratory changes related Several studies have demonstrated the great success of pha- to nasopharyngeal obstruction during sleep increase with age(21). ryngeal flap surgery in reducing or eliminating VPI symptoms Snoring during sleep, episodes of obstructive sleep apnea and in speech, with success rates varying between 25% and 98%(8- other daytime symptoms manifest themselves most often after 10). However, the pharyngeal flap is also associated with upper the age of 40 years(21-23). airway impairment, which may cause hyponasality, chronic The purpose of this study was therefore to determine the nasal obstruction, snoring and obstructive sleep apnea, symp- influence of age on nasopharyngeal dimensions and respiratory toms that interfere with respiratory function and, consequently, symptoms in patients who underwent surgery to correct velo- quality of life(11-14). pharyngeal insufficiency using the pharyngeal flap technique.