Abstract
BACKGROUND: Velopharyngeal insufficiency (VPI) is common in patients with repaired cleft palate. Speech surgery, which encompasses operative procedures to improve velopharyngeal function and speech resonance, is associated with postoperative obstructive sleep apnea (OSA). However, the relative risk of OSA between different speech surgery procedures remains unclear.
PURPOSE: The purpose of this study was to compare the relative risk of OSA following pharyngeal flap versus nonpharyngeal flap procedures, which included dynamic sphincter pharyngoplasty (DSP), Furlow palatoplasty, and buccal myomucosal flaps (BMMF).
DATA SOURCES: An electronic literature search was conducted utilizing PubMed, Cochrane, Embase, and Web of Science databases.
STUDY SELECTION: Eligible studies included patients with a history of repaired cleft palate and VPI requiring speech surgery, published between 1994 and 2024. Studies specifically included comparison data between pharyngeal flap and nonpharyngeal flap techniques. Exclusion criteria were case reports, abstracts, and reviews.
DATA EXTRACTION AND SYNTHESIS: Data were extracted per the the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Demographics, speech procedure data, OSA frequency, and follow-up data were recorded. The primary comparison was procedure type including pharyngeal flap versus non-pharyngeal flap procedures. Meta-analysis was performed using a random-effects model, with P values <.05 considered statistically significant.
MAIN OUTCOMES AND MEASURE: The primary outcome was relative risk of postoperative OSA between procedure types.
RESULTS: Four studies met inclusion criteria, which included 751 subjects. Pharyngeal flap use was associated with a significantly greater risk of postoperative OSA compared to nonpharyngeal flap procedures (pooled risk ratio = 2.45, 95% CI: 1.20 to 5.01, P = .01). Subgroup analysis demonstrated that palatal lengthening procedures had a significantly lower risk of OSA than pharyngeal flap (risk ratio = 0.39, P = .002); however, there was no difference in postoperative OSA between DSP and pharyngeal flap (P = .68) CONCLUSIONS AND RELEVANCE: Palatal lengthening procedures had a lower risk of postoperative OSA than pharyngeal flap. There was no difference in postoperative OSA between pharyngeal flap and DSP. As such, for patients with preoperative OSA or patients at high risk for developing OSA, it may be prudent to use palatal lengthening procedures as a first-line option for correction of VPI.