Postoperative airway findings after maxillomandibular advancement for obstructive sleep apnea syndrome.
OBJECTIVE
To evaluate the upper airway characteristics in the early postoperative period after maxilomandibular advancement for obstructive sleep apnea syndrome.


METHODS
Nasopharyngolaryngoscopy was performed before and 48 hours after surgery on 70 consecutive patients who underwent maxillomandibular advancement for obstructive sleep apnea syndrome. The preoperative and the postoperative evaluations were performed by the same examiner for consistency.


RESULTS
Mild to moderate lateral pharyngeal wall edema was identified in 70 consecutive patients. Fourteen patients (20%) had edema as well as ecchymosis involving the pyriform sinus and aryepiglottic fold. Four of these patients (6%) were also noted to have hypopharyngeal hematoma involving the pyriform sinus, aryepiglottic fold, arytenoid, and false vocal cord that partially obstructed the airway. These four patients were closely monitored for 1 to 2 additional days for possible expanding hematoma leading to airway compromise. None of these patients were found to have airway difficulty, and the minimum oxygen saturation was more than 90% throughout the hospitalization. All four patients were discharged uneventfully, and the hematoma resolved completely within 10 days.


CONCLUSIONS
Although postoperative edema was expected after maxillomandibular advancement, hypopharyngeal hematoma was unexpected. Although none of our patients had evidence of airway difficulty, the possibility of an expanding hypopharyngeal hematoma should be considered in patients complaining of breathing difficulty after maxillomandibular advancement surgery.
Li
K K
KK
Stanford University Sleep Disorders and Research Center, California, USA. kaseyli@hotmail.com
Riley
R W
RW
Powell
N B
NB
Zonato
A
A
Troell
R
R
Guilleminault
C
C
D000328:Adult; D004487:Edema / Q000209:etiology; D005260:Female; D006406:Hematoma / Q000209:etiology; D006801:Humans; D007013:Hypopharynx; D008297:Male; D019186:Mandibular Advancement; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures; D010608:Pharyngeal Diseases / Q000209:etiology*; D011183:Postoperative Complications; D011184:Postoperative Period; D011446:Prospective Studies; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D016896:Treatment Outcome