Postoperative Outcomes of Tonsillectomy With or Without Adenoidectomy in Children With Cleft Palate: A Scoping Review

BackgroundTonsillectomy with or without adenoidectomy (AT/T) is among the most common pediatric surgical procedures performed in the United States, but its outcomes in children with cleft palate are poorly characterized, with no consensus in the literature on risk profile. This scoping review examines and synthesizes the available evidence on functional outcomes and postoperative complications following AT/T in this population.MethodsPubMed, Embase, Web of Science, and Cumulative Index to Nursing and Allied Health Literature databases were searched, and study selection was reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews guidelines. Peer-reviewed articles reporting postoperative outcomes of AT/T in patients under 18-years-old with a history of cleft palate repair, performed either before or concurrently with AT/T, were included. Outcomes characterized included those relating to sleep-disordered breathing, hearing loss, perceptual speech characteristics, and velopharyngeal competency.ResultsOf 672 unique studies identified, 16 studies met the criteria for inclusion. Postoperative trends identified included improvements in sleep-disordered breathing (6 of 9 [66.7%] studies), generally stable or enhanced speech outcomes, and low rates of postoperative velopharyngeal insufficiency. Some evidence indicates that AT/T may provide benefit in reducing conductive hearing loss in this population. Surgical complication rates were reported infrequently and were highly variable among studies.ConclusionsFindings suggest that AT/T does not demonstrate a high risk of adverse postoperative outcomes and may provide benefit in pediatric patients with cleft palate. However, the available evidence is limited, and outcomes appear less predictable than in the general pediatric population, underscoring the necessity of thorough individualized assessment when making surgical decisions in children with cleft palate.