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Furlow Palatoplasty and Tonsillectomy for Treating Patients With Submucous Cleft Palate and Tonsillar Hypertrophy: A
Mosaad Abdel-Aziz1, Gamal Abdel-Fattah2, Nada M Abdel-Aziz3
1Department of Otolaryngology, Kasr Alainy Faculty of Medicine, Cairo University.
Insights
Performing tonsillectomy during cleft palate repair is feasible. This single-stage surgery improved speech and reduced sleep apnea symptoms in children with submucous cleft palate and tonsillar hypertrophy.
Area of Science:
- Pediatric Otolaryngology
- Craniofacial Surgery
- Sleep Medicine
Background:
- Children with cleft palate have narrower airways, increasing obstructive sleep apnea (OSA) risk.
- Tonsillar hypertrophy is a common OSA cause in children, often co-occurring with cleft palate.
- Submucous cleft palate (SMCP) repair may be complicated by tonsillar hypertrophy.
Purpose of the Study:
- To assess the feasibility of a single-stage tonsillectomy and Furlow palatoplasty in pediatric patients with SMCP and tonsillar hypertrophy.
- To evaluate the impact of this combined procedure on speech and velopharyngeal function.
- To determine the effect on daytime sleepiness in affected children.
Main Methods:
- Case series of 11 pediatric patients with SMCP and tonsillar hypertrophy.
- Simultaneous Furlow palatoplasty and tonsillectomy performed in one surgical session.
- Pre- and postoperative assessments included auditory-perceptual speech evaluation, nasometry, flexible nasopharyngoscopy, and the Epworth Sleepiness Scale for children/adolescents.
Main Results:
- Significant improvements in speech were observed, with reduced hypernasality and improved consonant clarity.
- Nasometry confirmed decreased nasalance scores, and flexible nasopharyngoscopy showed enhanced velar movement and closure.
- Excessive daytime sleepiness, present in 8 patients preoperatively, significantly improved post-surgery.
Conclusions:
- Simultaneous tonsillectomy and Furlow palatoplasty in SMCP patients is feasible and does not adversely affect speech or velopharyngeal function.
- This one-stage approach effectively addresses tonsillar hypertrophy, potentially preventing sleep-related breathing disorders and avoiding a second operation.
- Combining these procedures offers a streamlined treatment for pediatric patients with SMCP and concomitant tonsillar hypertrophy.
Background:
Children with cleft palate are more liable to have obstructive sleep apnea than children with normal palate due to narrow airways. Tonsillar hypertrophy is a common cause of pediatric obstructive sleep apnea; hence, it is not surprising to be encountered during cleft palate repair. The aim of this study was to evaluate the feasibility of tonsillectomy and Furlow palatoplasty performed as a 1-stage operation in patients presenting with submucous cleft palate (SMCP) and tonsillar hypertrophy.
Materials And Methods:
Eleven pediatric patients with SMCP and hypertrophied tonsils were included in this case series study. Furlow palatoplasty and tonsillectomy were performed for the patients in 1 sitting. The evaluation of velopharyngeal function was done preoperatively and postoperatively via auditory-perceptual-assessment, nasometry, and flexible nasopharyngoscopy. In addition, the Epworth sleepiness scale for children/adolescents was administered to the parents to assess daytime sleepiness of their children.
Results:
The speech improved postoperatively. Auditory-perceptual-assessment showed significant reductions in hypernasal speech, nasal air escape, and weak pressure consonants. In addition, nasometry revealed significantly decreased nasalance scores for nasal and oral sentences. A postoperative increased velar movement was observed with a significant improvement in velopharyngeal closure. The preoperative Epworth sleepiness scale for children/adolescents assessment revealed excessive daytime sleepiness in 8 patients, with significant improvement of scores postoperatively.
Conclusions:
Removal of hypertrophied tonsils during the repair of SMCP with Furlow palatoplasty did not negatively affect speech outcome or velar movement postoperatively. It is logical to perform both procedures simultaneously in 1 sitting to avoid postoperative sleep-related breathing disorder, which may necessitate a second stage operation.
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