Hypertrophied tonsils impair velopharyngeal function after palatoplasty

Area of Science:

• Pediatric Otolaryngology
• Speech-Language Pathology
• Craniofacial Surgery

Background:

• Tonsillar hypertrophy can cause airway obstruction in children with repaired cleft palate and velopharyngeal insufficiency.
• The impact of tonsillectomy on velopharyngeal function in this specific patient group requires detailed assessment.

Purpose of the Study:

• To evaluate the effect of hypertrophied tonsils on velopharyngeal function in children with a history of cleft palate repair.
• To quantify the impact of tonsillectomy on velopharyngeal closure and speech resonance postoperatively.

Main Methods:

• A case series design was employed, involving twelve children with repaired cleft palate and tonsillar hypertrophy.
• Preoperative and postoperative assessments included auditory perceptual speech evaluation, nasalance scoring, and flexible nasopharyngoscopy to assess velopharyngeal closure.

Main Results:

• Significant improvements were observed in speech parameters, including reduced hypernasality and nasal air emission, along with better pressure consonant production.
• Postoperative nasalance scores showed significant improvement, and a reduction in the velopharyngeal gap was noted.
• While not statistically significant, three patients achieved complete velopharyngeal closure after tonsillectomy.

Conclusions:

• Hypertrophied tonsils can negatively affect velopharyngeal function in children with repaired cleft palates.
• Tonsillectomy offers significant benefits, improving speech resonance and velopharyngeal closure, potentially obviating the need for secondary corrective surgeries.