Inspiration After Posterior Pharyngeal Flap Palatoplasty: A Preliminary Study Using Computational Fluid Dynamic Analysis

Posterior pharyngeal flap palatoplasty (PPF) is one of the most commonly used surgical procedures to correct speech, especially for patients suffering from velopharyngeal insufficiency (VPI). During PPF, surgeons use the catheter to control the lateral velopharyngeal port on each side. Airway obstruction and sleep apnea are common after PPF. To understand the air dynamics of the upper airway after PPF, we used computational fluid dynamics (CFD) to demonstrate the airflow. In our previous study, we have revealed the expiration process of the upper airway after PPF and shown the features of how PPF successfully restores the oral pressure for speech. In this study, we focus on examining the inspiration process. Normal airway structures were included. For the normal velopharyngeal structure, one cylinder was applied to each model. For recapitulating the velopharyngeal structure after PPF, two cylinders were used in each model. The ports for borderline/inadequate closure, which can help the oral cavity get the required pressure, were chosen for this study. A real-time CFD simulation was used to capture the airflow through the ports. We found that the airflow dynamics of the upper airway's inspiration were dependent on the velopharyngeal structure. Although the airflow patterns were similar, the velocities between one-port and two-port structures were different, which explained why patients after PPF breathed harder than before and suggested that the one-port structure might be a better choice for secondary VPI reconstruction based on the CFD analyses.

Obstructive Sleep Apnea Secondary to Pharyngeal Narrowing From Horizontal Donor Site Closure During Posterior Pharyngeal Flap Surgery

The posterior pharyngeal flap is frequently the surgical intervention of choice for the correction of velopharyngeal insufficiency. Our patient initially presented for a superiorly based, posterior pharyngeal flap to correct for velopharyngeal insufficiency. However, the postoperative recovery was complicated by severe obstructive sleep apnea, which warranted division and subsequent takedown of the flap. Despite flap takedown, our patient's obstructive sleep apnea persisted. The patient's clinical course suggests that donor site closure, and not the actual pharyngeal flap, caused the persistent obstructive sleep apnea.

A case report of application of posterior pharyngeal flap in resection and reconstruction of posterior pharyngeal wall carcinomas located at the level of the cricoid cartilage

RATIONALE

posterior pharyngeal wall carcinomas located at the level of the cricoid cartilage is a rare occurrence. Surgical treatment is a dilemma owing to the retention of laryngeal function PATIENT CONCERNS:: A 56-year-old man underwent a "resection of left cervical tumor" at another hospital. Postoperative pathological report noted a left metastatic squamous cell carcinoma of the neck. Neck-enhanced computed tomography (CT) revealed thickening of the right posterior pharyngeal wall, and an image of soft tissue density was present on the posterior pharyngeal wall with a size of approximately 1.0 × 1.5 cm.

DIAGNOSIS

Hypopharyngeal carcinoma (T1N2M0).

INTERVENTIONS

We performed operation on a patient who suffered from posterior pharyngeal wall carcinomas at the level of the cricoid cartilage. The postoperative defects were repaired with posterior pharyngeal flaps.

OUTCOMES

The patient with posterior pharyngeal flap after operation survived without necrosis, the neck wounds of patient healed in 1 stage, and the phonation, swallowing and respiratory function was good.

LESSONS

The application of posterior pharyngeal flap to repair defects due to posterior pharyngeal wall carcinomas that were located at the level of the cricoid cartilage after resection is an effective reconstruction method that is easy to use and has excellent repair effects.