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SLEEP DISORDERED BREATHING (SDB) AFTER PALATE RE-REPAIR IN CHILDREN WITH CLEFT PALATE: PRELIMINARY FINDINGS.
Introduction: Individuals with cleft palate are at risk for sleep-disordered breathing (SDB) due to facial abnormalities, maxillomandibular deformities, nasal airway impairment and palatal defects. The treatment involves several steps, including primary surgical closure of the palate and secondary correction of residual velopharyngeal insufficiency (VPI). The most commonly surgery used for VPI treatment has been the pharyngeal flap (PF) technique which promotes partial mechanical obstruction between the oro- and nasopharynx favoring VP closure. However, studies from our laboratory have shown that the PF is an additional risk factor for SDB in this population. In contrast, the Sommerlad palate re-repair, characterized by dissection and retroposition of velar muscles, seems to be less obstructive than the PF.
Objective: To investigate the frequency of SDB symptoms in nonsyndromic children with repaired cleft palate±lip who underwent the Sommerlad palate re-repair and correlate findings with pharyngeal patency indicators.
Methods: Fifteen subjects with VPI, aged 6 to 17 years (10 years, on average) were included in the study so far. None of them had enlarged tonsils. All were assessed before and after surgery (13 months, on average). Snoring and excessive daytime sleepiness (ES) were investigated using standardized questionnaires (Sleep Disturbance Scale for Children-SDSC and Epworth Sleepiness Scale). Nasopharyngeal area and speech nasalance (the acoustic correlate of nasality) were assessed by rhinomanometry and nasometry, respectively. Informed consent was obtained (institutional ERB No.1,905,404).
Results: Before surgery, snoring was reported by 5(33%) of the parents and ES by 4(27%). After surgery, the number increased to 7(47%) and 6(40%). The differences were not significant (p>0.05). No surgery complications such as bleeding, airway obstruction, dehiscence and fistula were observed. Confirming clinical observations, subnormal nasopharyngeal area and hyponasality, suggesting decrease in pharyngeal patency, were not observed on the instrumental methods.
Conclusion: Preliminary data suggest that the Sommerlad palate re-repair has less impact on sleep breathing than the one reported for PF surgery. Identifying a lower effect of Sommerlad’s surgery on sleep quality will be a relevant contribution for the treatment of cleft-related VPI.
Sleep Apnea, Snoring, Sleepiness, Cleft Palate, Velopharyngeal Insufficiency.
Bauru School of Dentistry-FOB-USP - Sao Paulo - Brasil, Hospital for Rehabilitation of Craniofacial Anomalies, HRAC-USP - Sao Paulo - Brasil
ANDRESSA SHARLLENE CARNEIRO SILVA, Bruna Mara Adorno Marmontel Araújo, Carlos Eduardo Bertier, Telma Vidotto de Sousa Brosco, Ana Paula Fukushiro, Renata Paciello Yamashita, Sérgio Henrique Kiemle Trindade, INGE ELLY KIEMLE TRINDADE