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Concomitant adenotonsillectomy and cleft palate repair in one sitting
Mosaad Abdel-Aziz1, Abdel-Rahman El-Tahan2, Assem Abdel-Wahid3
1Department of Otolaryngology, Faculty of Medicine, Cairo University, el-salam st., King Faisal, above el-baraka bank, Giza, Cairo, Egypt. mosabeez@yahoo.com.
Insights
Adenotonsillectomy during cleft palate repair in children with adenotonsillar hypertrophy effectively prevents breathing issues without negatively impacting speech. This combined approach offers significant benefits for pediatric patients.
Area of Science:
- Pediatric Otolaryngology
- Craniofacial Surgery
- Speech Pathology
Background:
- Adenotonsillar hypertrophy (ATH) presents a surgical challenge during cleft palate (CP) repair.
- The decision for concurrent adenotonsillectomy requires careful consideration of potential impacts on speech and breathing.
Purpose of the Study:
- To evaluate the effectiveness of adenotonsillectomy performed concurrently with cleft palate repair in children with ATH.
- To assess the impact on both speech and breathing outcomes.
Main Methods:
- Nine children with CP and ATH underwent simultaneous adenotonsillectomy and palatoplasty.
- Speech and velopharyngeal function were evaluated using auditory perceptual assessment and nasometry at age 4.
Main Results:
- No postoperative obstructive breathing episodes were reported by parents.
- Six patients had normal nasality, three had mild hypernasality; nasalance scores were comparable to controls.
- Velopharyngeal closure was competent in 4, borderline in 3, and borderline incompetent in 2 patients.
Conclusions:
- Concurrent adenotonsillectomy during cleft palate repair is safe for speech.
- This procedure effectively prevents obstructive breathing episodes post-surgery in children with ATH.
Purpose:
When adenotonsillar hypertrophy (ATH) is encountered in children during cleft palate (CP) repair, the decision for adenotonsillectomy is challenging. The aim of this study was to evaluate the effectiveness of adenotonsillectomy done during CP repair for children with ATH on speech and breathing.
Methods:
Nine children with CP and ATH underwent adenotonsillectomy prior to palatoplasty in same sitting. The age of patients ranged between 1.5 and 3.5 years with a mean age of 2.3 years at the time of operation. Auditory perceptual assessment (APA), nasometric assessment, and velopharyngeal function evaluation were performed when the children reached the age of 4 years.
Results:
No children developed obstructive breathing episodes postoperatively as witnessed by parents. APA showed normal nasality in six patients and mild hypernasality in three patients. Nasalance scores for both nasal and oral sentences were found to be comparable with that of normal children of the same age. Velopharyngeal closure was seen competent in four patients, borderline competent in three patients, and borderline incompetent in two patients.
Conclusion:
Performing adenotonsillectomy during CP repair does not deleteriously affect the speech and it prevents the occurrence of postoperative obstructive breathing episodes that may be caused by the hypertrophied tonsils and/or adenoid.
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