Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-10T12:30:00.611Z Has data issue: false hasContentIssue false
  • English
  • Français

Velopharyngeal insufficiency in patients without a cleft palate: important considerations for the ENT surgeon

Published online by Cambridge University Press:  06 March 2020

E Mushi ,
N Mahdi ,
N Upile ,
C Hevican ,
S McKernon ,
S van Eeden  and
S De
E Mushi*
Affiliation:
Otolaryngology and Head and Neck Surgery Department, University Hospital Aintree, Liverpool, UK
N Mahdi
Affiliation:
Royal Manchester Children's Hospital, UK
N Upile
Affiliation:
Otolaryngology Head and Neck Surgery Department, Queen Victoria Hospital NHS Foundation Trust, West Sussex, UK
C Hevican
Affiliation:
Department of Plastics and Reconstructive Surgery, University College Hospital Galway, Ireland
S McKernon
Affiliation:
University of Liverpool, UK
S van Eeden
Affiliation:
Department of Cleft Lip and Palate and Maxillofacial, Alder Hey Children's Hospital, Liverpool, UK
S De
Affiliation:
Department of Otolaryngology and Head and Neck Surgery, Alder Hey Children's Hospital, Liverpool, UK
*
Author for correspondence: Ms Eriola Mushi, Otolaryngology and Head and Neck Surgery Department, University Hospital Aintree, Lower Lane, LiverpoolL9 7AL, UK E-mail: eriola.mushi@liverpoolft.nhs.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Velopharyngeal insufficiency is the inability to close the velopharyngeal port during speech and swallowing, leading to hypernasal speech and food regurgitation.

Objective

This study aimed to explore the aetiological factors contributing to the development of velopharyngeal insufficiency in a non-cleft paediatric population, especially following adenoidectomy.

Methods

A retrospective case review was conducted of all children without a known cleft palate, born between 2000 and 2013, who were referred to a tertiary cleft centre with possible velopharyngeal insufficiency.

Results

The data for 139 children diagnosed with velopharyngeal insufficiency following referral to the cleft centre were analysed. Thirteen patients developed the condition following adenoidectomy; only 3 of these 13 had a contributing aetiological factor.

Conclusion

Velopharyngeal insufficiency is a rare but significant complication of adenoidectomy. The majority of patients who developed velopharyngeal insufficiency following adenoidectomy did not have an identifiable predisposing factor. This has important implications for the consent process and when planning adenoidectomy.

Keywords

Velopharyngeal InsufficiencyAdenoidectomySubmucous Cleft PalateInformed Consent
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 134 , Issue 3 , March 2020 , pp. 252 - 255
Copyright
Copyright © JLO (1984) Limited, 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Ms E Mushi takes responsibility for the integrity of the content of the paper

This work was presented: as a poster at the 15th British Academic Conference in Otolaryngology, 8–10 July 2015, Liverpool, UK, orally at the British Association of Paediatric Otolaryngology annual meeting, 18 September 2015, Dublin, Ireland, and orally at the European Society of Paediatric Otolaryngologists Congress, 18–21 June 2016, Lisbon, Portugal.

References

Siegel-Sadewitz, VL, Shprintzen, RJ. Changes in velopharyngeal valving with age. Int J Pediatr Otorhinolaryngol 1986;11:171–82CrossRefGoogle ScholarPubMed
Calnan, JS. Movements of the soft palate. Br J Plast Surg 1953;5:286–96CrossRefGoogle ScholarPubMed
Gibb, AG. Hypernasality (rhinolalia aperta) following tonsil and adenoid removal. J Laryngol Otol 1958;72:433–51CrossRefGoogle ScholarPubMed
Witzel, MA, Rich, RH, Margar-Bacal, F, Cox, C. Velopharyngeal insufficiency after adenoidectomy: an 8-year review. Int J Pediatr Otorhinolaryngol 1986;11:15–20CrossRefGoogle Scholar
Lowe, D, Brown, P, Yung, M. Adenoidectomy technique in the United Kingdom and postoperative hemorrhage. Otolaryngol Head Neck Surg 2011;145:314–18CrossRefGoogle ScholarPubMed
Saunders, NC, Hartley, EJ, Sell, D, Sommerlad, B. Velopharyngeal insufficiency following adenoidectomy. Clin Otolaryngol Allied Sci 2004;29:686–8CrossRefGoogle ScholarPubMed
Tweedie, D, Skilbeck, C, Wyatt, M, Cochrane, L. Partial adenoidectomy by suction diathermy in children with cleft palate, to avoid velopharyngeal insufficiency. Int J Pediatric Otorhinolaryngol 2009;73:1594–7CrossRefGoogle ScholarPubMed
Ysunza, PA, Bloom, D, Chaiyasate, K, Rontal, M, VanHulle, R, Shaheen, K et al. Velopharyngeal videofluoroscopy: providing useful clinical information in the era of reduced dose radiation and safety. Int J Paediatr Otorhinolaryngol 2016;89:127–32CrossRefGoogle ScholarPubMed
Goudy, S, Ingraham, C, Canady, J. Noncleft velopharyngeal insufficiency: etiology and need for surgical treatment. Int J Otolaryngol 2012;2012:296073CrossRefGoogle ScholarPubMed
Perkins, A, Sie, K, Gray, S. Presence of 22q11 deletion in postadenoidectomy velopharyngeal insufficiency. Arch Otolaryngol Head Neck Surg 2000;126:645–8CrossRefGoogle ScholarPubMed
Ali, NJ, Pitson, D, Stradling, JR. Natural history of snoring and related behaviour problems between the ages of 4 and 7 years. Arch Dis Child 1994;71:74–6CrossRefGoogle ScholarPubMed
Guilleminault, C. Discussion on the influence of craniofacial structure on obstructive sleep apnea in young adults. J Oral Maxillofac Surg 1998;56:602–3CrossRefGoogle Scholar
Finkelstein, Y, Wexler, D, Berger, G, Nachmany, A, Shapiro-Feinberg, M, Ophir, D. The anatomical basis of sleep related breathing abnormalities in children with nasal obstruction. Arch Otolaryngol Head Neck Surg 2000;126:593–600CrossRefGoogle ScholarPubMed
Murray, N, Fitzpatrick, P, Guarisco, JL. Powered partial adenoidectomy. Arch Otolaryngol Head Neck Surg 2002;128:792–6CrossRefGoogle ScholarPubMed
Donnelly, MJ. Hypernasality following adenoid removal. Ir J Med Sci 1994;163:225–7CrossRefGoogle ScholarPubMed