Post-operative Complications in Pharyngeal Flap Surgery

Abstract

In surgery involving the oral cavity, generally, the close proximity of the airways offers abundant possibilities of respiratory complications. This is particularly the case regarding surgical procedures in the pharynx. Much attention has always been given to the refinement of surgical techniques and anesthesiological measures with the prospect of eliminating respiratory complications arising both during and after the opera— tion as well in the post-operative period. Yet, in spite of all the care taken, complications do occur, especially during the post-operative period. In the present paper, a large series of pharyngeal flaps is discussed regarding post-operative complications and anesthesiological techniques. Brief Historical Survey A review of the technique of the pharyngeal flap is presented elsewhere (11). Schonborn (14), the originator of both upper-and lower-based pharyngeal flaps, performed his first operation of this kind in 1874. In 1886 (15),he reported on 20 pharyngeal flap cases. There was one death in that series, from pneumonia. Kindler (3) reported on four cases of pharyngeal flap operations. One patient died, from mediastinitis, probably due to infection in the upper respiratory tract. Thanks to modern anesthesiological methods and also to the availability of chemotherapeutic and antibiotic agents, there has been a remarkable decline in the frequency of serious complications arising in connection with surgical procedures in the pharynx, such as deaths from pneumonia, while at the same time the number of operations has greatly increased (16). The trend for such a decline is evidenced from the results of a study by Musgrave and Bremner (10). In that series of 780 cases of cleft palate and pharyngeal flap operations two deaths occurred, one being that of a 23-month—old child. The death in this case was due to surgical factors, namely unreplaced blood loss probably associated with some degree of asphyxia.