Airway obstruction following palatoplasty of a patient with sleep disturbance

provided the original work is properly cited. CC Cleft palate is the most common craniofacial anomaly, with an incidence of 1 in 700 live births. Primary corrective palatal surgery is often performed between 6 and 12 months. Although cleft palate closure may result in upper airway obstruction, tracheostomy is a rare complication after repair of cleft palate in patients without any other craniofacial abnormalities [1]. Here, we report a child who was presented without other craniofacial abnormalities but required unplanned tracheostomy to resolve an airway compromised after repair of cleft palate. A 9-month old female weighing 7.4 kg was scheduled for correction of complete cleft palate. History taking from her parents revealed that the baby had difficulty in breathing in the supine position but appeared to breathe comfortably in the left or right lateral decubitus position during sleep. Her chest radiograph did not show any abnormal findings. Preoperative 3D-computed tomography (CT) of the head and neck revealed sufficient airway patency (Fig. 1A). Other laboratory findings were within normal ranges. In the operating room, the initial oxygen saturation was 99% in room air, and other vital signs were stable. We induced sevoflurane in gradual increments from 2 to 4% with oxygen using a mask and injected rocuronium bromide 3 mg. We intubated the patient with armored tube 3.0 mm at 11 cm from the incisor. Laryngoscopy visual field according to the Cormack-Lehane grades was grade 2. General anesthesia was maintained with sevoflurane (end-tidal concentration of 1.0-2.0%). Operation time was about fifty minutes. At the end of surgery, the operator notified us that the posterior part of the tongue was significantly large. Extubation was carried out when