title: Respiratory failure after superior-based pharyngeal flap for velopharyngeal insufficiency: A rare complication.
abstract: Velopharyngeal insufficiency (VPI) is an uncommon pediatric disorder often associated with congenital syndromes. After speech therapy, surgery is the standard management. Many surgical approaches to VPI repair have been reported and the complications of these procedures are well documented. To date, there have been no published cases of respiratory failure secondary to pneumomediastinum, pneumopericardium, and bilateral pneumothoraces with associated subcutaneous emphysema after superior-based pharyngeal flap. We present the first case in the literature. Our proposed etiology for the respiratory failure is air tracking from the flap donor site to the pleural spaces of the thoracic cavity via the visceral or prevertebral fascia following positive pressure ventilation.
authors.affiliation: Tulane University School of Medicine, Department of Otolaryngology/Head and Neck Surgery, New Orleans, LA, USA. Electronic address: clawlor@tulane.edu.
authors.forename: Claire M
authors.initials: CM
authors.lastname: Lawlor
authors.affiliation: Tulane University School of Medicine, Department of Otolaryngology/Head and Neck Surgery, New Orleans, LA, USA.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Riley
authors.affiliation: Tulane University School of Medicine, Department of Otolaryngology/Head and Neck Surgery, New Orleans, LA, USA.
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Hildrew
authors.affiliation: Tulane University School of Medicine, Department of Otolaryngology/Head and Neck Surgery, New Orleans, LA, USA; Ochsner Clinic Foundation, Department of Pediatric Otolaryngology, New Orleans, LA, USA.
authors.forename: J Lindhe
authors.initials: JL
authors.lastname: Guarisco
mesh_terms: D002675:Child, Preschool; D005260:Female; D006801:Humans; D008478:Mediastinal Emphysema / Q000000981:diagnostic imaging / Q000209:etiology; D010614:Pharynx / Q000601:surgery*; D011026:Pneumopericardium / Q000000981:diagnostic imaging / Q000209:etiology; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000209:etiology; D011175:Positive-Pressure Respiration / Q000009:adverse effects; D011183:Postoperative Complications; D011859:Radiography; D012131:Respiratory Insufficiency / Q000209:etiology*; D013352:Subcutaneous Emphysema / Q000209:etiology; D013524:Surgical Flaps; D014681:Velopharyngeal Insufficiency / Q000601:surgery*
keywords: Pharyngeal flap; Respiratory failure; Velopharyngeal insufficiency