Effect of cleft palate repair with vomer flap on obstructive sleep apnea incidence

Cleft lip with or without cleft palate is the most common congenital anomaly of head and neck with an estimated incidence of 1 case per 700 live births. Patients may experience problems with speech, hearing, feeding and midface development. As being one of the most important patient group of plastic surgery, cleft lip and palate treatment requires multidisciplinary team care. Single or two-staged midline repairs with intravelar veloplasty and z-plasty techniques are the most preferred surgical procedures in cleft palate treatment but there is no consensus on a single treatment protocol. There are different approaches on surgical repair timing among cleft centers. Early repairs of cleft palate provides better speech outcomes while late repairs may avoid midface growth disturbances. Vomer flap is the most common procedure for repairing nasal mucosa, especially in wide clefts. Alteration of airflow and upper airway dimensions in cleft palate patients leads to higher incidinces of sleep related breathing disorders when compared to normal pediatric population. Sleep related obstructive events are especially more frequent after primary palatoplasty. Pharyngeal flap surgery is the most common procedure for treating velopharyngeal insufficiency and it can result with obstructive sleep apnea syndrome (OSAS) in postoperative period. If left untreated, OSAS leads to daytime sleep, neurocognitive, cardiovascular disorders and behavioral problems. In our study, it is hypothesised that using vomer flap during palatoplasty increases nasal airway obstruction and OSAS in cleft palate patients. 17 patients which were treated for cleft palate in our clinic and underwent polysomnography for evaluating OSAS were included in our study. Comparison of polysomnographic findings between cleft palate patients who were treated by palatoplasty with vomer flap and palatoplasty alone, revealed that there was no statistically significant difference related to OSAS criterias. Although this study has proved that vomer flap is a safe procedure in cleft palate treatment, these patients are in high risk group for OSAS. The symptoms and clinical findings in cleft palate patients must be carefully analyzed when there is any suspicion for sleep related breathing disorders.