Pregledni rad
https://doi.org/10.20471/acc.2023.62.s1.11
Is Surgical Treatment of Velopharyngeal Insufficiency by Myomucosal Posterior Pharyngeal Flap a Contraindication for Nasal Intubation? A Narrative Review
Iva Smiljanić
; Department of Anesthesiology, Resuscitation and Intensive Care Medicine, Dubrava University Hospital, Zagreb, Croatia
Predrag Knežević
; Department of Maxillofacial and Oral Surgery, Dubrava University Hospital, Zagreb, Croatia
Morena Milić
; Department of Anesthesiology, Resuscitation and Intensive Care Medicine, Dubrava University Hospital, Zagreb, Croatia; Dubrovnik University, Dubrovnik, Croatia
Marko Tarle
; Department of Maxillofacial and Oral Surgery, Dubrava University Hospital, Zagreb, Croatia
Perislav Lauš
; Department of Anesthesiology, Resuscitation and Intensive Care Medicine, Dubrava University Hospital, Zagreb, Croatia
Ivo Jurišić
; Department of Anesthesiology, Resuscitation and Intensive Care Medicine, Dubrava University Hospital, Zagreb, Croatia
Sažetak
Velopharyngeal insufficiency is a disorder where the soft palate directs the air
through the nose. It is often present in patients with previous cleft or short palate, but also in many
other conditions. Symptoms are primarily to be found in speech, with very distinct nasal sound. After
clinical evaluation and nasal endoscopy, surgery is considered. Several surgical techniques are in use,
with posterior pharyngeal flap pharyngoplasty being most widely used. This method leaves the base
of the posterior pharyngeal flap attached to the posterior pharyngeal wall, with two lateral ports on
each side of the flap. Permanent nasopharyngeal obstruction is a very challenging pathology for anesthesiologists
in case of mandatory nasal intubation since it is a relative contraindication for nasal
intubation. Patients with previous palatoplasty will regularly appear in our routine anesthetic practice,
in all surgical segments. The high risk of damage to the flap with possible bleeding can put the anesthesiologist
in a very unpleasant situation if not aware of the permanent effect of this surgery. During
preanesthetic assessment, if there is information on a previous pharyngoplasty, one should consider
alternative options for nasotracheal intubation. All nasal insertion procedures must be either avoided
or carried out with great caution, under fiberoptic visual control.
Ključne riječi
Velopharyngeal insufficiency; Iatrogenic nasopharyngeal obstruction; Nasal intubation; Airway
Hrčak ID:
307479
URI
Datum izdavanja:
1.4.2023.
Posjeta: 278 *