Trans-oral endoscopic partial adenoidectomy does not worsen the speech after cleft palate repair.
INTRODUCTION
Adenoid hypertrophy may play a role in velopharyngeal closure especially in patients with palatal abnormality; adenoidectomy may lead to velopharyngeal insufficiency and hyper nasal speech. Patients with cleft palate even after repair should not undergo adenoidectomy unless absolutely needed, and in such situations, conservative or partial adenoidectomy is performed to avoid the occurrence of velopharyngeal insufficiency. Trans-oral endoscopic adenoidectomy enables the surgeon to inspect the velopharyngeal valve during the procedure.


OBJECTIVE
The aim of this study was to assess the effect of transoral endoscopic partial adenoidectomy on the speech of children with repaired cleft palate.


METHODS
Twenty children with repaired cleft palate underwent transoral endoscopic partial adenoidectomy to relieve their airway obstruction. The procedure was completely visualized with the use of a 70° 4mm nasal endoscope; the upper part of the adenoid was removed using adenoid curette and St. Claire Thompson forceps, while the lower part was retained to maintain the velopharyngeal competence. Preoperative and postoperative evaluation of speech was performed, subjectively by auditory perceptual assessment, and objectively by nasometric assessment.


RESULTS
Speech was not adversely affected after surgery. The difference between preoperative and postoperative auditory perceptual assessment and nasalance scores for nasal and oral sentences was insignificant (p=0.231, 0.442, 0.118 respectively).


CONCLUSIONS
Transoral endoscopic partial adenoidectomy is a safe method; it does not worsen the speech of repaired cleft palate patients. It enables the surgeon to strictly inspect the velopharyngeal valve during the procedure with better determination of the adenoidal part that may contribute in velopharyngeal closure.
['Abdel-Aziz|Mosaad|M|', 'Khalifa|Badawy|B|', 'Shawky|Ahmed|A|', 'Rashed|Mohammed|M|', 'Naguib|Nader|N|', 'Abdel-Hameed|Asmaa|A|']
D000233:Adenoidectomy D000234:Adenoids D000402:Airway Obstruction D002648:Child D002675:Child, Preschool D002972:Cleft Palate D000075202:Contraindications D005260:Female D006801:Humans D006984:Hypertrophy D008297:Male D016896:Treatment Outcome D014833:Voice Quality
Cleft palate Adenoid hypertrophy Velopharyngeal insufficiency Endoscopic adenoidectomy Adenoidectomia endoscópica Fenda palatina Hipertrofia da adenoide Insuficiência velofaríngea