Severe Obstructive Sleep Apnea After Pharyngeal Fat Injection for Velopharyngeal Insufficiency

A 3-month-old male with a chromosomal deletion (8p11.23) underwent cleft lip and palate repair with a postoperative polysomnogram (PSG) showing mild obstructive sleep apnea. He underwent multiple surgical interventions for persistent sleep apnea in subsequent years with minimal improvement. Due to persistent hypernasality, he underwent harvest and injection of autologous fat to the posterior pharyngeal wall, followed by repeat injection and low-drape extension 3-stitch revision palatoplasty. At follow up, hypernasality and snoring were improved. However, he subsequently developed severe OSA with AHI 59.5. He underwent sleep endoscopy in spring 2023 which showed a large soft mass at the posterior pharyngeal wall with significant impingement on the airway to the level of the epiglottis, requiring excision of an extensive lipomatous mass. The patient has not presented for follow-up exam or a repeat sleep study, though his mother reports improvement in snoring. Surgical providers should be aware that this significant postoperative complication may occur and require further surgical intervention.