RESUMEN
ABSTRACT 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° 4 mm 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.
Resumo Introdução: A hipertrofia da adenoide pode desempenhar um papel no fechamento velofaríngeo, especialmente em pacientes com anormalidade palatal; a adenoidectomia pode levar à insuficiência velofaríngea e fala hipernasal. Os pacientes com fenda palatina, mesmo após a correção, não devem ser submetidos a adenoidectomia, exceto quando absolutamente necessário e, em tais situações, a forma conservadora ou parcial é realizada para evitar a ocorrência de insuficiência velofaríngea. A adenoidectomia endoscópica transoral permite ao cirurgião inspecionar a válvula velofaríngea durante o procedimento. Objetivo: O objetivo deste estudo foi avaliar o efeito da adenoidectomia parcial endoscópica transoral na fala de crianças submetidas à correção de fenda palatina. Método: Um total de 20 crianças com fenda palatina previamente corrigida, foi submetida a adenoidectomia parcial endoscópica transoral, para desobstrução das vias aéreas,. O procedimento foi completamente visualizado com o uso de um endoscópio de 4 mm e ângulo de 70º; a parte superior da adenoide foi removida com uma cureta para adenoide e fórceps St. ClaireThompson, enquanto a parte inferior foi conservada para manter a competência velofaríngea. Avaliações da fala foram realizadas nos períodos pré e pós-operatório, de forma subjetiva pelaavaliação perceptivo-auditiva, e objetiva pela avaliação nasométrica. Resultados: A fala não foi prejudicada após a cirurgia. A diferença entre os escores da avaliação perceptivo-auditiva e nasalância para as sentenças nasais e orais nos períodos pré e pós-operatório foi insignificante (p = 0,231, 0,442, 0,118, respectivamente). Conclusões: A adenoidectomia parcial endoscópica transoral é um método seguro, e não piora a fala dos pacientes com fenda palatina operada. Ela permite que o cirurgião inspecione rigorosamente a válvula velofaríngea durante o procedimento, com melhor determinação da parte adenoide que pode contribuir para o fechamento velofaríngeo.
Asunto(s)
Humanos , Masculino , Femenino , Preescolar , Niño , Calidad de la Voz , Adenoidectomía/métodos , Fisura del Paladar/cirugía , Tonsila Faríngea/patología , Resultado del Tratamiento , Obstrucción de las Vías Aéreas/cirugía , Contraindicaciones , Hipertrofia/cirugíaRESUMEN
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.