Postoperative Management and Complications

As with any intervention that involves resection of the soft palate, significant morbidity is observed in the first

24-72 h postoperatively, in the form of significant pain and dysphagia. The ability of the patient to tolerate at least a liquid diet, oral pain medications, antibiotics, and steroids determines the moment when the patient can be safely discharged. While discharge could in theory be on the same day as the surgery, most patients will need 1 or 2 days of intravenous fluids and medications before they can start an oral diet. Prior to discharge, patients are prescribed acetaminophen with codeine elixir, as needed for pain. Pain medication requirements average 6.5 days; the same goes for the pro-

Fig. 36.9. Two-layered closure of the palatal flaps with 3-0 chromic suture. (Reprinted from Friedman et al. [7] copyright 2004, with permission from the American Academy of Otolaryngology - Head and Neck Surgery Foundation)
Fig. 36.10. Lateral view showing the widening of the nasopharynx after Z-palatoplasty. (Reprinted from Friedman et al. [7] copyright 2004, with permission from the American Academy of Otolaryngology - Head and Neck Surgery Foundation)

gression from liquid or soft diet, to regular diet. Postoperative antibiotics and steroids are also recommended, for a total of 7 days. Additional TBRF sessions may be necessary, depending on the improvement of symptoms in each individual patient.

Complications of the procedure are comparable to those of classic UPPP (Table 36.2). Bleeding is always a potential complication, and the risk is again comparable to that of classic UPPP. Typically, patients can eat a regular diet after 2 weeks. Mild VPI may manifest when drinking quickly, and may persist for up to 3 months. After 3 months, patients have normal deglutition. The severity of VPI symptoms diminishes with time, and is expected to progressively resolve. Permanent VPI is a potential complication that must be considered by every patient. Additional morbidity of the procedure is usually related to throat discomfort symptoms, including globus sensation, mild dysphagia, dry throat, and the inability to clear the throat. These symptoms are almost universal after any form of UPPP.

Other complications are related to the adjunctive procedures performed. Tongue-base infection is related to TBRF and requires antibiotic treatment. In rare cases, it may lead to tongue-base abscess formation, which may require incision and drainage.

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