Velopharyngeal incompetence and persistent hypernasality after adenoidectomy in children without palatal defect

Persistent hypernasal speech after adenoidectomy has been reported in children with palatal deficiency. Hypernasality after adenoidectomy can also occur in children with normal palatal function. The aim of the present study was to identify the cause of velopharyngeal incompetence and hypernasality after adenoidectomy in children who did not have palatal defect as a predisposing factor. Sixteen children who developed hypernasality after adenoidectomy were included in the present study. Standard lateral cephalometry, videofluoroscopy, and nasopharyngoscopy were performed to visualize the velopharynx and its function during speech. The results showed that enlarged tonsils and prominent remaining adenoid tissue on the posterior pharyngeal wall were the causes of hypernasality in these children. Incomplete removal of the adenoid tissue should be avoided and enlarged tonsils should be removed at the time of adenoidectomy to prevent the risk for postoperative hypernasality.