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Partial adenoidectomy by suction diathermy in children with cleft palate, to avoid velopharyngeal insufficiency
Daniel J Tweedie1, Christopher J Skilbeck, Michelle E Wyatt
1Department of Paediatric Otolaryngology, Great Ormond Street Hospital for Children, London, United Kingdom. dtweedie@doctors.org.uk
Insights
Partial adenoidectomy using suction diathermy is safe and effective for children with repaired cleft palate, resolving nasal obstruction and breathing issues without causing velopharyngeal insufficiency (VPI). This procedure offers symptom relief while avoiding VPI complications.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Speech Pathology
Background:
- Adenoidectomy treats pediatric nasal obstruction, sleep-disordered breathing, and otitis media with effusion (OME).
- Velopharyngeal insufficiency (VPI) is a rare but serious complication of adenoidectomy, particularly in patients with pre-existing velopharyngeal dysfunction, such as those with cleft palate.
- Adenoidectomy is often avoided in children with cleft palate history due to VPI concerns, potentially limiting treatment options.
Purpose of the Study:
- To evaluate the efficacy and safety of partial adenoidectomy using suction diathermy in children with a history of overt cleft palate repair.
- To determine if this selective adenoid tissue resection can resolve symptoms of nasal obstruction or sleep-disordered breathing without inducing VPI.
Main Methods:
- A cohort of 18 patients with previously corrected overt cleft palate underwent partial adenoidectomy between 1994 and the study period.
- The procedure involved transoral, indirect vision resection of adenoid tissue using a malleable suction coagulator, allowing selective removal.
- Patients were monitored for symptom improvement and speech outcomes, including perceptual assessment for VPI, over a median follow-up of 92 months.
Main Results:
- All patients experienced symptomatic improvement for their initial indications (nasal obstruction, sleep-disordered breathing, OME).
- No patients developed worsening hypernasal speech or other signs of VPI post-surgery.
- No instances of symptomatic adenoidal regrowth were observed during the follow-up period.
Conclusions:
- Partial adenoidectomy via suction diathermy is a safe and effective technique for children with a history of overt cleft palate repair.
- This approach allows for targeted adenoid tissue removal to address obstructive symptoms while mitigating the risk of VPI.
- The study supports the use of this technique to provide therapeutic benefits for indicated conditions without compromising velopharyngeal function.
Objectives:
Adenoidectomy is indicated for the relief of paediatric nasal obstruction, sleep-disordered breathing and otitis media with effusion (OME). Velopharyngeal insufficiency (VPI) is a rare complication. The main risk factor is the presence of pre-existing velopharyngeal closure-impaired mechanisms, including submucosal or overt cleft palate. Despite possible benefits, adenoidectomy is frequently withheld in such children to avoid VPI. This study aims to demonstrate the efficacy and safety of partial adenoidectomy using suction diathermy in children who previously underwent overt cleft palate repair during infancy, to allow selective resection of tissue and symptom resolution without producing VPI.
Methods:
Since 1994, 18 patients with previously corrected overt cleft palate have undergone partial adenoidectomy at this centre, for the treatment of nasal obstruction or sleep-disordered breathing, with or without OME. Three had existing VPI following their cleft correction surgery. Selective resection of the adenoid was performed transorally under indirect vision, using a malleable suction coagulator. This allowed exposure of the posterior choanae, leaving the remaining adenoid bulk intact.
Results:
Patients were followed up at 4 weeks, and subsequently at regular intervals (total follow up 30-180 months, median 92 months), including perceptual speech assessment in all cases. All demonstrated symptomatic improvement with respect to the original indications for surgery. None developed worsening hypernasal speech or other features of VPI, and there were no cases of symptomatic adenoidal re-growth.
Conclusions:
Partial adenoidectomy, employing a variety of methods, has been used successfully in children with submucosal cleft palate. This study demonstrates the safe and effective use of suction diathermy to enable partial adenoidectomy in children who have previously undergone surgical correction of overt cleft palate, allowing symptom resolution without producing VPI.
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